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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006005
Report Date: 09/27/2024
Date Signed: 09/27/2024 12:06:53 PM

Document Has Been Signed on 09/27/2024 12:06 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 COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:OAKMONT OF HUNTINGTON BEACHFACILITY NUMBER:
306006005
ADMINISTRATOR/
DIRECTOR:		ACOSTA-LOUER, SANDRAFACILITY TYPE:
740
ADDRESS:18922 DELAWARE STREETTELEPHONE:
(657) 204-4600
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: 111CENSUS: 169DATE:
09/27/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:07 AM
MET WITH:Executive Director Christine GreenwayTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 09/20/2024, Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced Annual Inspection Visit using the CARE inspection tool. Due to time constraints LPA was unable to complete visit. On today's date LPA has made unannounced visit to complete Annual Inspection. LPA was greeted by staff and granted entry after stating the purpose of the visit.

LPA meet with Executive Director Christine Greenway for today's continued inspection. The facility is licensed for one hundred eleven (111) non-ambulatory residents, eight (8) Bedridden with approved hospice waiver for fifteen (15) residents. Currently, there are nine (9) Hospice residents present during today’s visit. Facility is a Four story building including basement. Facility has three floors of resident apartments. First floor has a secured Memory Care unit. Facility has Bistro area, fitness center, library, salon, computer/ activities room, dining room and movie theater.

LPA conducted a tour of the physical plant accompanied by Executive Director, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. LPA tested water temperature inside six resident bathrooms and were operational with water temperature measured at 105.0- 105.4 degrees F. A comfortable temperature of 78 degrees F. was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed facility Emergency food and water supply and observed 25 dining kits, 24 breakfast food kits that make uo to 150 servings per box in each kit. LPA observed facility has two emergency water tanks with 2029 expiration date. Facility has multiple Fire extinguishers per floor and LPA observed 12 extinguishers which were fully charged, mounted and accompanied by a flashlight.

CONTINUED ON 809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: OAKMONT OF HUNTINGTON BEACH
FACILITY NUMBER: 306006005
VISIT DATE: 09/27/2024
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A review of the Medication Records Administration (MAR) was conducted for six residents, and LPA observed the records are in compliance.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted including Emergency Disaster Plan, Personal property/ theft policy, Personal Rights and compliance poster. LPA observed an Activities Calendar posted in activity room and common areas. LPA observed books, puzzles, games, computers with internet access and craft activities available for resident use as well as outside Garden area and dog park.

LPA observed First Aid Kit was maintained. A working landline phone was operational at front reception. LPA observed the last fire drill inspection was conducted on October 25, 2023 by Cal Building Systems. Last Annual Fire inspection by Cal Building Systems included facility had tested & passed 244 operational smoke and carbon monoxide detectors in all floors bedrooms and common areas. Last Fire drill was conducted on 07/28/2024. The facility has current liability insurance on file effective 03/01/2024 - 03/01/2025. The facility is current on Community Care Licensing annual dues.

A review of six residents (R1-R6) service files and Seven staff (S1-S7) personnel files revealed to be complete. The facility has the current administrator's certification on file for Christine Greenway # 7003850740 - Expiration 04/18/2026.

No deficiencies during this inspection visit.

An exit interview was conducted with Executive Director, and a copy of the report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC809 (FAS) - (06/04)
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