<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005795
Report Date: 12/02/2020
Date Signed: 12/03/2020 11:55:38 AM

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 FULLERTONFACILITY NUMBER:
306005795
ADMINISTRATOR:FERNANDEZ, TAMARAFACILITY TYPE:
740
ADDRESS:433 WEST BASTANCHURY ROADTELEPHONE:
(707) 535-3200
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:152CENSUS: 0DATE:
12/02/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tamara Fernandez, Vice President of OperationsTIME COMPLETED:
04:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst, Kathrina Chin contacted the facility via telephone and Facetime for a pre-licensing evaluation due to COVID-19 and for pre-cautionary measures. LPA Chin identified herself and spoke to Tamara Fernandez, Vice President of Operations.

The main structure is a three story building which includes 94 resident units in total. The entire community was designed to accommodate 152 non-ambulatory residents. There is a Memory Care unit on the first floor and has a capacity for 35 residents. There are three delayed egress exits on the first floor. A fire clearance was granted on October 8, 2020 for 152 non-ambulatory residents of which 8 may be bedridden on the first floor only. This facility has submitted a hospice waiver request for 8 residents.

LPA toured the entire community, interior and exterior, including a sampling of resident bedroom units. Hot water were tested in 10 apartment units and observed to be between 105-108 degrees Fahrenheit. Fire extinguishers were mounted and charged. Smoke detectors were centrally wired throughout and have been checked by the fire department. Carbon monoxide detectors are operational. There was one E-Vacs chairs near each of the three stairwells at the facility. There was one locked medication room on the first two floors and had a first aid kit in each medication room. There were several locked closets for storage of toxins and cleaning equipment. An emergency call system was in place in each apartment unit and several were tested.
The kitchen area was checked. There were emergency food supplies and water. LPA observed activity calendars, theft and loss policy, residents rights, admission agreement, resident rights and emergency plans were posted including the Ombudsman and Let Us Know poster. The Memory Care unit has their own activity room/ living room area and dining area. LPA reviewed the outdoor area and observed a patio structure and outdoor furniture. (Continued on LIC 809C)
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 FULLERTON
FACILITY NUMBER: 306005795
VISIT DATE: 12/02/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued)

An Abbreviated Component III was conducted with Tamara Fernandez, V.P.

It appears that this facility meets the requirements for licensure. Both the license and the hospice waiver will be granted upon final review and approval from the Central Applications Bureau.
.

An exit teleconference was conducted with Tamara Fernandez, V.P. and LPA Chin discussed and read this report. A copy of this report will be provided via email. Tamara Fernandez agreed to confirm the receipt of the document, review the report and return a signed copy.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2