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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208908
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:39:49 PM


Document Has Been Signed on 05/02/2022 02:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:WESTMONT OF FRESNOFACILITY NUMBER:
107208908
ADMINISTRATOR:HAMILTON, PAMELAFACILITY TYPE:
740
ADDRESS:7442 & 7468 N MILLBROOK AVETELEPHONE:
(858) 729-6720
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:155CENSUS: 76DATE:
05/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Administrator, Pamela HamilitonTIME COMPLETED:
02:52 PM
NARRATIVE
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On 05/02/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Case Management - Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Pamela Hamilton.

The purpose of today's inspection is to follow up on an incident that occurred on 04/18/2022. It was reported that at the beginning of S2's shift, S2 observed a Medication cup with morning medications poured for R1, but the medications were not administered. S1 was did not administer morning medications, however: S1 documented that medications were given to R1.

A deficiency is being issued in accordance with the California Code Regulations, Title 22, Division 6 on the attached 809D.

An exit interview was conducted and a Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Pamela Hamilton, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/02/2022 02:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: WESTMONT OF FRESNO
FACILITY NUMBER: 107208908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/03/2022
Section Cited

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87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirementw as not met as evidenced by:
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Based on record review and interviews, the Licesnee did not ensure all residents were assisted with self-administered medications as needed. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
LIC809 (FAS) - (06/04)
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