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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005740
Report Date: 09/05/2023
Date Signed: 09/05/2023 11:05:30 AM


Document Has Been Signed on 09/05/2023 11:05 AM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:OAKMONT OF ORANGEFACILITY NUMBER:
306005740
ADMINISTRATOR:ALYSON CALUZAFACILITY TYPE:
740
ADDRESS:630 THE CITY DRIVE SOUTHTELEPHONE:
(714) 880-8624
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:155CENSUS: 93DATE:
09/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Alyson Caluza, Anna PastoresTIME COMPLETED:
11:20 AM
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This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting additional interviews to follow up on self-reported incident reports received in the Orange County Regional Office (OCRO) on 08/16/23 regarding an incident of rough handling resulting in injuries involving Staff #1 (S1), Resident #1 (R1) and Resident #2 (R2). LPA met with Health Services Director (HSD) Alyson Caluza and discussed the purpose of the inspection. Administrator (AD) Anna Pastores arrived during the inspection.

During today’s inspection, LPA and AD toured the facility. LPA conducted health and safety checks on R1 and R2, conducted interviews, and observed them to be in good health and observed no health and safety issues. LPA interviewed AD, 7 residents, and reviewed S1’s staff file.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023
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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