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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700863
Report Date: 03/11/2021
Date Signed: 03/11/2021 01:36:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:OAKMONT OF WESTPARKFACILITY NUMBER:
312700863
ADMINISTRATOR:FERNANDEZ, TAMERAFACILITY TYPE:
740
ADDRESS:2400 PLEASANT GROVE BLVDTELEPHONE:
(916) 789-2000
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:142CENSUS: DATE:
03/11/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tamera Fernandez and Harvey FongTIME COMPLETED:
11:20 AM
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Licensing Program Analyst(LPA) Hiratsuka, contacted the facility via telephone due to COVID-19 and pre-cautionary measures. The purpose of this call is conducting an announced prelicensing visit. LPA spoke to Applicant/Administrator Tamera Fernandez and Harvey Fong. Administrator held the camera to show LPA the facility. Mr. Fong is the future administrator of the facility.

This facility has a fire clearance for 134 non-ambulatory and eight bedridden for a total of 142 residents. This facility has two floors. This facility also has a memory care unit that has delayed egress. There is an outside courtyard in the middle of this building. The courtyard has a fountain that is not a hazard to the residents. The memory care unit is located on the first floor of the facility and consists of rooms 111-131 and 144-152. There are 22 private resident apartments and five shared apartments. There are different floor layouts for the shared resident apartments and all have full private bathrooms. There is a dining, sitting, activity , and music areas for the residents in the memory care unit. There is a locked medication room and laundry room in the unit. The food serving area has cooking and heating appliances that have a separate switch to turn off the appliances that is not accessible to the residents when not in use. There is also a separate bathing area that has a walk-in tub that may be used with supervision. There is an office and training room.

The assisted living side has 60 apartments. There are two different studio layouts, four one-bedroom layouts, and two different two-bedroom layouts. There are 10 studio, 40 one-bedroom, and 10 two-bedroom apartments. The two-bedroom apartments have a full kitchen and one layout has two full bathrooms. The studio and one-bedroom apartments have kitchenettes. Some of the one and two-bedroom apartments have a clothes washer and dryer. The first floor has all the administration offices, kitchen, dining, beauty salon, medication room, multiple common areas, and a few assisted living resident apartments. The second floor has resident apartments, staff laundry room, laundry room for resident use, staff break room, and a couple of common areas for the residents.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: OAKMONT OF WESTPARK
FACILITY NUMBER: 312700863
VISIT DATE: 03/11/2021
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Component III orientation was conducted.

This facility meets all regulations. LPA is going to submit this report to the application specialist for final review.

LPA is going to email a copy of this report to Administrator and Administrator is to sign, and email a copy back to LPA.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2