306005795-12-19-2022-22-AS-KSGH-CM9UHR-20221219143623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005795
Report Date: 12/19/2022
Date Signed: 12/19/2022 02:36:32 PM

Document Has Been Signed on 12/19/2022 02:36 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	OAKMONT OF FULLERTON		FACILITY NUMBER:	306005795
ADMINISTRATOR:	LINDSAY SCHROEDER		FACILITY TYPE:	740
ADDRESS:	433 WEST BASTANCHURY ROAD		TELEPHONE:	(714) 869-1940
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	152	CENSUS: 111	DATE:	12/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lindsay Schroeder, Executive Director		TIME COMPLETED:	03:00 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 (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual investigation focusing on Infection Control procedures. LPA arrived at facility and was greeted and granted entry by Lindsay Schroeder, Executive Director after explaining the purpose of the visit. At approximately 12:45 PM, LPAs toured the facility with Executive Director. Facility has 111 residents in care including 35 in the Memory Care Unit. A total of nine residents are currently receiving hospice care. All units minus one studio unit are currently occupied and Memory Care is at capacity. Facility consists of one 3-level building for both Assisted Living and Memory Care, which is located exclusively on the ground level. LPA observed a cafe/lounge area, dining room, private dining area, a reading room on the ground level. The third level also has an activities room, a large multi-purpose room, a movie theater, wellness office for physical therapy and the Assisted Living medication room. The activity program is displayed in multiple locations throughout the facility and tailored to the needs of independent and memory care residents respectively. An ample supply of activity materials and reading materials is observed during the visit. LPAs observed residents relaxing in the facility's common areas or in their respective bedrooms. All residents appeared happy and well taken care of. Facility is clean, sanitary and free of odors in all areas inspected. LPAs observed the facility's central kitchen and observed it to be sanitary and fully stocked. The temperatures observed for both the walk-in refrigerator and freezer are noted to be in compliance with regulations. Special diets are observed to be documented in the kitchen for any residents with special dietary needs. LPAs observed multiple outside visitation areas. There are no bodies of water on the premises. Residents identified as at risk of elopement are equipped with bracelets that notify staff of their identity as well as the exit used when they exit the building. CONTINUED ON FORM LIC809-C

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: OAKMONT OF FULLERTON	FACILITY NUMBER: 306005795
	VISIT DATE: 12/19/2022

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CONTINUED FROM FORM LIC809. LPA observed a large patio with an ample quantity of outdoor furniture and shade. Two gated exit routes are observed behind the physical plant, with self-latching gates equipped with push bars and monitored through the wander guard. A secure dog park is present for residents with pets. Raised beds for gardening are observed. The Memory Care unit is equipped with a dedicated patio and outdoor space with no means of egress for the unit's residents and their visitors. Visitors can freely enter the Memory care unit and are provided a door code in order to safely exit.

All resident rooms had the required elements. Rooms are a combination of studio, one bedroom and two bedroom apartments in Assisted Living. Memory Care rooms are a combination of 21 private studios and 7 companion rooms. Bathroom are observed to be clean and without obstructions. The walk-in showers are equipped with anti-slip floors and handrails. A fixed resident call system is observed in the bathrooms with additional pendants available.

All visitors are required to sign in upon entering the facility. Facility takes resident and staff temperatures daily and documents. Facility has an ample supply of PPE available and stored PPE and isolation station are supplied for providing and disposing of PPE in the event of active COVID cases. There are no active COVID cases in the facility at this time.

Facility is equipped with two medication rooms, one for Assisted Living and the other one for the Memory Care unit. LPAs observed both rooms with MedTech staff present. Rooms are secured by key lock when Med Tech staff is absent from the room and are confirmed to be adequately locked during the visit. Each room is equipped with a medication cart and a locked refrigerator for controlled substances requiring refrigerated storage. Approximately 30 out of the 111 residents are currently on Medication Management.

LPAs requested and obtained the facility's Fire Alarm and Life Safety System maintenance and inspection records during the visit. All systems were noted as fully functional per inspection reports dated 05/06/2022. Last two documented inspections and testing of the sprinkler system were successfully conducted on 03/24/2022 and 05/27/2022. Quarterly fire safety drills were documented as conducted. A staff roster and updated proof of liability insurance were also requested and obtained.

No deficiencies cited. A exit interview was conducted with the facility representative and a copy of the report was provided and left at facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC809 (FAS) - (06/04)

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