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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603479
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:43:38 PM


Document Has Been Signed on 09/26/2024 01:43 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:OAKMONT OF WHITTIERFACILITY NUMBER:
198603479
ADMINISTRATOR:HILL, JANETTEFACILITY TYPE:
740
ADDRESS:13617 WHITTIER BLVD.TELEPHONE:
(562) 693-8222
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:97CENSUS: 72DATE:
09/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Adriane RungeTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA) Elizabeth Irra conducted an annual inspection visit. LPA met with Adriane Runge and discussed the purpose of today’s visit.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Facility has an Infection Control Policy (binder) in place.

Operational Requirements: Facility is adhering to the operational requirements. This facility is approved for (97) non-ambulatory residents (7 of which may be bedridden and 15 of which may be under hospice). There are currently (47) residents in the assisted living facility and (25) memory care residents.

Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detectors observed. The fire extinguishers are located throughout the facility and appear to be full (last service date 03/27/24). Signal system tested and operable. Last emergency drill was conducted on 08/29/24. Emergency evacuation chairs were observed at the stairways. Hot water temperature measured within regulations. The hot water supply measured at the following temperatures: 106.5* to 110.0*. Bathrooms have non-skid surfaces and grab bars.

Staffing: Facility is adhering to staffing requirements.

Refer to LIC 809C for the continuation of this report.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: OAKMONT OF WHITTIER
FACILITY NUMBER: 198603479
VISIT DATE: 09/26/2024
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Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for S-1 through Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting and Resident Rights.

Resident Rights-Information: Resident rights are posted and included in Resident files.

Planned Activities: This facility has an activity room and provides a variety of activities for the residents. Activity schedule is posted.

Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating in both the assisted living and memory care dining rooms.

Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #7 (R-7). Resident files are maintained at the facility. Resident files have the required documents. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Assessment Summary, Resident Rights were observed.

Disaster Preparedness: The facility has a Disaster Preparedness manual (binder) in place.

Health Related Services/Incidental Medical Services: The medications are stored and locked (medication carts) inside the medication room.

Exit interview conducted, copy of appeal rights and a copy of this report was provided to Adriane Runge.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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