306005795-4-12-2022-22-AS-KCHN-CDEVX7-20220412164905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005795
Report Date: 04/12/2022
Date Signed: 04/12/2022 04:49:17 PM

Document Has Been Signed on 04/12/2022 04:49 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 FULLERTON		FACILITY NUMBER:	306005795
ADMINISTRATOR:	KNEEDY-CAYEM, KARA		FACILITY TYPE:	740
ADDRESS:	433 WEST BASTANCHURY ROAD		TELEPHONE:	(714) 869-1940
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	152	CENSUS: 102	DATE:	04/12/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Eva Duarte, Health Services Director		TIME COMPLETED:	05:00 PM

NARRATIVE

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This unannounced case management visit is being conducted by Licensing Program Analyst (LPA), Kathrina Chin to follow up on a GI outbreak reported to Community Care Licensing on 4/11/2022. LPA arrived at facility and met with Eva Duarte, Health Services Director.

Eva Duarte, HSD reported that the infectious GI virus started on 4/4/2022 in Memory Care and she reported that the seven cases was reported to Orange County Public Health and the licensing office and the licensing office on 4/7/2022 via email. LPA suggested on 4/8/2022 to send an incident report( LIC 624 )to the licensing office. All seven residents were isolated in their apartment and was resolved on 4/9/2022.

Ms. Duarte spoke to the nurse from Orange County Public Health Department today and she suggested to use disposable utensils, plates and cups for the next three days.

Eva Duarte stated that the stomach virus is now in the Assisted Living area which she reported yesterday to have a total of eight resident in Assisted Living. As of today, there are thirteen residents with the GI symptoms and no staff. All thirteen residents are self-isolating. Eva Duarte stated that visitors are discouraged to visit the residents who have the GI virus. Ms. Duarte stated that all the staff were in-serviced on infection control. Ms. Duarte stated that one physician came to visit two residents with the GI virus and he did not believe that it was the Norovirus because of the presenting symptoms.

At this time, based on the information available, there are no deficiencies being cited per Title 22 of the California Code of Regulations.

An exit interview interview was conducted and a copy of this report provided to the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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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