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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209036
Report Date: 09/12/2023
Date Signed: 09/12/2023 04:01:35 PM


Document Has Been Signed on 09/12/2023 04:01 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:OAKMONT OF NORTH FRESNOFACILITY NUMBER:
107209036
ADMINISTRATOR:SETTY, HEIDIFACILITY TYPE:
740
ADDRESS:5605 N GATES AVETELEPHONE:
(559) 277-5959
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:122CENSUS: 77DATE:
09/12/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Andrea YescasTIME COMPLETED:
02:47 PM
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a Health and Safety Inspection in conjunction with a 10 – Day complaint visit (Control Number 24-AS-20230911151045). LPA met with and explained the reason for the visit with Memory Care Director (MCD) Andrea Yescas.

LPA toured the facility with Monica Corona, the facility Engagement Coordinator (S1). During the tour, LPA observed residents throughout the facility and in their apartments. Paper products, towels, linens and hygiene supplies were observed. Resident apartments toured, required furniture and lighting in place. The facility was clean, walkways and doorways were free of obstruction. LPA toured the kitchen while lunch was being prepared and observed required perishable and non-perishable food supply and sharps stored correctly. LPA observed residents in AL and MC participating in activities and freely ambulating through the facility. LPA observed outdoor courtyards with seating areas and delayed egress gates in working order. Medication rooms and carts were observed to be locked and inaccessible to residents. Fire extinguishers dated 12/28/22. Administrator certificate expires 7/29/24.


Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 9099-D.


An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with MCD, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/12/2023 04:01 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: OAKMONT OF NORTH FRESNO
FACILITY NUMBER: 107209036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/13/2023
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible...
The requirement was not met as evidenced by:
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Facility has agreed to remove all medications from the room until all required documentation and assessments are complete for both residents. Resident assessments will be updated to document the status determined.
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Licensee did not ensure that medications were centrally stored and locked. Over the counter medications were observed accessible to R1 and R2. Required documentation and assessments were not maintained in resident files.
This poses an immediate health, safety or personal rights risk to persons in care.
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A written statement will be submitted to CCLD by POC date which outlines the procedure taken for proper medication storage for R1 and R2.
Request Denied
Type A
09/13/2023
Section Cited
CCR87309(a)

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87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
This requirement was not met as evidenced by:

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Items were immediately removed from the room. Staff conducted a check of each room for any solutions that need to be locked and inaccessible. An in-service will be conducted for all care staff. A written statement of these procedures and in-service will be submitted to CCL by the POC date.
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Licensee did not ensure that disinfectants, cleaning supplies and poisons… were inaccessible to residents in Memory Care. Cleaning supplies and laundry detergent were observed in 116.

This poses an immediate health, safety or personal rights 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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
LIC809 (FAS) - (06/04)
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