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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216803904
Report Date: 10/12/2020
Date Signed: 10/12/2020 01:30:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:OAKMONT OF NOVATOFACILITY NUMBER:
216803904
ADMINISTRATOR:RIVERA, MELONFACILITY TYPE:
740
ADDRESS:1465 S NOVATO BLVDTELEPHONE:
(628) 215-1200
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:118CENSUS: 0DATE:
10/12/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melon Rivera - Executive DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Fernandes-Goes conducted a pre-licensing inspection and met with Executive Director Melon Rivera. Fire clearance has been approved for 110 Non-ambulatory and eight bedridden - 1st. floor residents by the Marin County Fire Department. LPA will conduct a component III orientation with Melon Rivera Executive Director, Jason Engelhorn.

LPA toured facility and observed: Facility is two floors, in good repair and at a comfortable temperature. Hot water temperature checked between 120.3 and 106.3 degrees F in 8 out of 8 resident's faucets as required by Title 22 Regulations. The facility has a phone line designated for residents use. Personnel and residents' records are stored at the facility office. Facility plans on having awake staff.

The main floor includes kitchen, dining area, activities area, bar and lounge, lobby, fitness area, beauty salon, bistro, reading room, living room, laundry room, office rooms, medication room, Traditions (memory care) and Assisted Living resident's bedrooms. Second floor includes media room, staff room, emergency food supply, assisted living resident's bedrooms. All resident's bedroom have their own bathroom. Traditions has 7 double bedrooms. Facility plans on having several different activities available for residents as desired and has an activity calendar posted. There is outdoor space for activities. Menus for dining are posted on the table and at entrance. Special diets will be posted on a kitchen board with pictures and Traditions will have a binder for special diets. Toxins will be locked in chemical room on first floor. Facility also has community restrooms downstairs. Postings noted to be current and in compliance with guidelines. Locked cabinets for sharps and daily used toxins in Traditions under the sink kitchen area. First aid kit was observed. PPE closet observed and carts to store PPE in case needed - facility has ordered PPE and will be in contact with MCPH (Marin County Public Health) for COVID-19 guidance.

Facility is cleared for licensure.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Carla Fernandes-GoesTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
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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