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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700863
Report Date: 03/18/2022
Date Signed: 03/18/2022 10:56:20 AM


Document Has Been Signed on 03/18/2022 10:56 AM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OAKMONT OF WESTPARKFACILITY NUMBER:
312700863
ADMINISTRATOR:CASSIANA BUSHFACILITY TYPE:
740
ADDRESS:2400 PLEASANT GROVE BLVDTELEPHONE:
(916) 789-2000
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:142CENSUS: DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Antonette Edwards, Executive DirectorTIME COMPLETED:
11:05 AM
NARRATIVE
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Licensing Program Analyst (LPA) K.. Hiratsuka, arrived at the facility unannounced on 03/18/2022 to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Administrator Antonette Edwards, Executive Director, and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms.. LPA ensured they applied hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Receptionist.

LPA and Antonette Edwards, Executive Director toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Executive Director completed the infection control domain and facility was found to be in substantial compliance at this time.

A couple of topics discussed.


No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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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