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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005795
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:17:13 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: 24DATE:
07/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Kara Kneedy-Cayem, Executive DirectorTIME COMPLETED:
03:18 PM
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 Licensing Program Analyst (LPA), Jim August contacted the facility regarding a self reported incident. LPA August identified herself and spoke to Kara Kneedy-Cayem, Executive Director.

LPA August spoke to Kneedy-Cayem regarding resident #1 (R1), who eloped from the facility on July 25, 2021 and was found the same day in the facility parking lot. R1 did not sustain any injuries and was redirected back inside the facility. The facility will conduct an in-service training with staff and ensure that the delayed egress doors at the memory care section are checked every 30 minutes. In addition R1 will utilize a wander guard for increased monitoring.

No deficiency cited 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 via email.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James AugustTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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