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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002798
Report Date: 06/20/2024
Date Signed: 06/20/2024 12:41:46 PM


Document Has Been Signed on 06/20/2024 12:41 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:OAKMONT OF ROSEVILLEFACILITY NUMBER:
315002798
ADMINISTRATOR:PARVANEH MANOUCHEHRIFACILITY TYPE:
740
ADDRESS:1101 SECRET RAVINE PARKWAYTELEPHONE:
(916) 771-6700
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:120CENSUS: 83DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:PARVANEH MANOUCHEHRITIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the full care tool. LPA met with Executive Director, Parvaneh Manouchehri, and explained the purpose of the visit.

Today's census is 83 residents with nine residents on hospice services. Facility is licensed for 120 residents, hospice waiver of 15.

During today's inspection, LPA and Executive Director conducted a tour the interior and exterior of the facility. Areas toured included but not limited to: courtyard, memory care unit bedrooms, assisted living unit bedrooms, bistro, main dining, private dining, kitchen, library, and the common areas. LPA observed care staff assisting residents with walking and other activities. LPA observed the facility to be clean, safe and in good repair.

File review was conducted for 10 residents and 10 personnel files. LPA observed the files to be completed with the required documents. Inspection tool completed and found facility to be in substantial compliance.

Executive Director and LPA discussed today is Executive Director's last day with this role as new director will start effective Monday.

At this time, LPA is requesting facility liability insurance to be emailed to LPA by Friday June 28, 2024.

No deficiencies observed during today's inspection. Exit interview conducted and a copy of report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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