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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005795
Report Date: 07/20/2021
Date Signed: 07/20/2021 04:31:02 PM

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:
(714) 869-1940
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:152CENSUS: 80DATE:
07/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Kara Kneedy-Cayem, Executive DirectorTIME COMPLETED:
04:45 PM
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 Licensing Program Analyst (LPA), Kathrina Chin made an unannounced site visit for the purpose of a case management-incident. LPA Chin identified herself and spoke to Kara Kneedy-Cayem, Executive Director.

LPA, Kathrina Chin spoke to Kara Kneedy-Cayem, Executive Director regarding resident #1(R1). LPA explained that the purpose of this visit is to discuss an SOC 341 incident/report which occurred on July 16, 2021. Resident 1 claimed she was flung from her wheelchair to her bed on that day and that staff can do better. LPA asked if a different set of staff can transfer her when needed. Resident 1 said that would be a good change.

The following items will be changed in order to facilitate better transfers for residents:

1) Staff will be re-trained on transfers and better communication during transfers.
2) The facility has ordered a new sling for the hoyer lift. This hoyer lift will be utilized for resident #1's transfers.
3) Resident 1 has requested a change of staff who will lift her during transfers.

No deficiency cited this review as per Title 22 of the California Code of Regulations.

An exit interview was conducted and a copy of this report was provided to Kara Kneedy-Cayem, Executive Director.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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