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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209036
Report Date: 04/26/2022
Date Signed: 04/26/2022 01:26:18 PM


Document Has Been Signed on 04/26/2022 01:26 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:GUSTIN, PATRICIAFACILITY TYPE:
740
ADDRESS:5605 N GATES AVETELEPHONE:
(559) 277-5959
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:122CENSUS: 80DATE:
04/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Heidi SettyTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Infection Control Inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Heidi Setty. LPA entered through the central entry point where hand sanitizer and Staff/Visitor Health Screening area was observed.

Infection control procedures which were observed and/or reviewed by LPA include: Daily symptoms screenings (for staff, residents and visitors), testing, vaccination, visitation requirements, quarantine/isolation procedures, staffing, PPE and daily infection control procedures.

LPA toured the facility inside and out including resident apartments in Assisted Living and Memory Care units. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed resident medication and 30-day supply of PPE. Hand sanitizer is available at the entrance of each common area and throughout. LPA observed cleaning and disinfecting products. Bathroom sinks are stocked with liquid soap, paper towels, and covered trash cans were observed. LPA observed food supply, paper goods and emergency supplies. Required postings as well as Covid and hand washing signs are up throughout the facility.


No deficiencies cited during this inspection.

A copy of this report was provided via email to hsetty@oakmontmg.com, and an exit interview was conducted with AD. Administrator Certificate expiration date 7/29/2022

LPA requested the following updated forms by 5/9/22: LIC 308, LIC 309,LIC 500, LIC 610E, LIC 9020 and a Copy of current Liability Coverage
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
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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