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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002955
Report Date: 12/09/2022
Date Signed: 12/20/2022 01:47:51 PM


Document Has Been Signed on 12/20/2022 01:47 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OAKMONT OF WESTPARKFACILITY NUMBER:
315002955
ADMINISTRATOR:EDWARDS, ANTONETTEFACILITY TYPE:
740
ADDRESS:2400 PLEASANT GROVE BLVD.TELEPHONE:
(916) 545-8904
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:142CENSUS: 103DATE:
12/09/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Antonette Edwards, Executive DirectorTIME COMPLETED:
01:30 PM
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On 12/9/2022 LPA Tryon visited the facility to conduct a pre-licensing visit using the Pre-licensing CARES Tool. LPA met with Executive Director Antonette Edwards.
LPA, ED and Gabriel Morton, Maintenance Director toured the facility including common areas, apartments, assisted living and memory care, kitchen, dining areas, hallways, Medication Rooms, storage, laundry, recreation areas, etc. LPA viewed posted rights, complaint contact poster, files and paperwork, etc.

We viewed enclosed courtyards/outside areas, shutoff areas, electrical panels.

At this time, LPA is waiving the Orientation Component III requirement, as the Administrator has been working in facilities for an extended period of time; and the new licensee has other facilities that it has owned. Therefore, Component III is not necessary.

The facility appears to be in compliance with regulations, very clean, nicely furnished and everything in good condition.

Prior to inspection, LPA noted that the new fire clearance does not mention delayed egress; and there are delayed egress doors and outside gates in the facility. This issue was discussed with the worker in Central Applications Bureau, who will follow up with whatever is needed on the fire clearance.

No deficiencies noted at this visit. Exit interview conducted. Findings will be forwarded to the Central Application Bureau.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
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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