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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005740
Report Date: 09/21/2023
Date Signed: 09/21/2023 12:51:34 PM


Document Has Been Signed on 09/21/2023 12:51 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:OAKMONT OF ORANGEFACILITY NUMBER:
306005740
ADMINISTRATOR:ANNA PASTORESFACILITY TYPE:
740
ADDRESS:630 THE CITY DRIVE SOUTHTELEPHONE:
(714) 880-8624
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:155CENSUS: 102DATE:
09/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Anna PastoresTIME COMPLETED:
01:00 PM
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This unannounced Case Management – Other inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering an amended report for the Case Management – Incident inspection conducted on 08/24/23 and to conduct 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 Administrator (AD) Anna Pastores and discussed the purpose of the inspection.

During the inspection, LPA and AD reviewed and discussed the previously delivered report and the amended report and LPA delivered the amended report. During the inspection, LPA also conducted interviews and requested and reviewed resident records. LPA provided technical assistance regarding resident transfers and care plans.

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 copies of this report and the amended report were 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: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023
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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