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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
315002955
Report Date:
10/16/2023
Date Signed:
10/16/2023 12:41:15 PM
Document Has Been Signed on
10/16/2023 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 WESTPARK
FACILITY NUMBER:
315002955
ADMINISTRATOR:
THOMAS, HALEY
FACILITY TYPE:
740
ADDRESS:
2400 PLEASANT GROVE BLVD.
TELEPHONE:
(916) 545-8904
CITY:
ROSEVILLE
STATE:
CA
ZIP CODE:
95747
CAPACITY:
142
CENSUS:
86
DATE:
10/16/2023
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
11:45 AM
MET WITH:
Haley Thomas
TIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Kerry Hiratsuka and Lavinia Muscan conducted an unannounced case management visit on 10/16/2023. This is in response to a death report submitted by the facility on 10/08/2023.
LPAs met with Administrator Haley Thomas. LPAs requested and obtained a copy of the entire file for the resident.
Further investigation by Community Care Licensing Division is required.
No deficiencies cited.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR NAME:
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE:
10/16/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/16/2023
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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