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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006005
Report Date: 08/09/2022
Date Signed: 08/09/2022 12:30:44 PM


Document Has Been Signed on 08/09/2022 12:30 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 HUNTINGTON BEACHFACILITY NUMBER:
306006005
ADMINISTRATOR:ACOSTA-LOUER, SANDRAFACILITY TYPE:
740
ADDRESS:18922 DELAWARE STREETTELEPHONE:
(657) 204-4600
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:111CENSUS: 76DATE:
08/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director Sandra Acosta-Louer and Health Services Director Edith RamirezTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of an annual visit. LPA Tirre was greeted and granted entry to the facility by front desk receptionist and had temperature checked upon entrance. LPA met with Executive Director Sandra Acosta-Louer and Health Services Director Edith Ramirez and discussed purpose of visit.

At approximately 9:45 am, LPA Tirre observed facilities Infection Control Plan and Mitigation Plan. At 9:55 am LPA Tirre conducted tour with Executive Director and Health Services Director. During today's inspection visit, LPA observed the following:


Structure: Facility is a three story building housing 46 apartments in the assisted living and 32 apartments in the memory care unit. Facility offers a beauty salon, media room, gym, activities room, several dining areas as well as outside patio areas. Living Room/ Dining Room: Adequate seating is available in the main dining room and visiting areas. Bedrooms Residents: LPA observed several resident rooms on all three floors. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Rooms contain a kitchen area complete with a fridge. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. All common area restrooms have toilet paper, paper towels and proper hand washing signs. Emergency Phone Numbers and Exit Plan: Posted in entrance of facility. Food Service: LPA Observed Facility kitchen and food storage areas. Facility has ample perishable and non perishable food supplies. LPA observed emergency food and water supply. LPA observed a posted menu with multiple choices for residents. Facility has dining room areas for Memory care and Assisted living.Smoke Detectors: LPA observed documentation on 4/7/2022 an annual inspection with Cal Building Systems was done on Carbon monoxide and smoke detectors were tested operational. Fire extinguishers observed are fully charged. Toxins: Facility has several secured areas which are inaccessible to residents in care. Medications: Facility uses electronic medication administration record. Resident & Staff File: LPA reviewed staff and resident files during the visit. LPA observed 7 out of 7 resident files. All files reviewed have updated Emergency contact info and Updated Physician's report. CONTINUED ON LIC 809C
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: OAKMONT OF HUNTINGTON BEACH
FACILITY NUMBER: 306006005
VISIT DATE: 08/09/2022
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LPA observed outside patio areas with ample shade both located on first floor. Facility has several designated areas for visitation. LPA observed evacuation chair near stairwell. Facility has ample supply of PPE.

During visit LPA observed staff members wearing face masks. LPA observed residents relaxing in apartments as well as engaged in group activities.

No deficiencies found at this time. An exit interview was conducted with Executive Director and Health Services Director and a copy of this report was left at the facility
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC809 (FAS) - (06/04)
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