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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002955
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:35:21 PM


Document Has Been Signed on 04/19/2023 02:35 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



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:
04/19/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Antonette Edwards, AdministratorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to the facility to interview Administrator. LPA met with Antonette Edwards during todays visit. Todays visit is regarding allegations on a different facility license regarding complaint #59-AS-20230412130752. Allegation is not directed to this current facility.

No deficiencies were found during today's inspection.

Exit Interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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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