<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700601
Report Date: 06/26/2020
Date Signed: 06/26/2020 04:14:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:OAKMONT OF FAIR OAKSFACILITY NUMBER:
342700601
ADMINISTRATOR:BAKER, CARIEFACILITY TYPE:
740
ADDRESS:8484 MADISON AVENUETELEPHONE:
(916) 633-1001
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:128CENSUS: 83DATE:
06/26/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Terry Ervin, Executive DirectorTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Angela Hood and Michael Hood spoke with the Executive Director, Terry Ervin, via telephone to conduct a case management visit. Today's visit was conducted by telephone due to COVID-19 and precautionary measures. The purpose of the visit is to follow-up on two incident reports that were received by the Department.

On 6/1/20, resident (R1), who resides in the memory care (transitions) section of the facility, had two rings and a necklace reported missing.

On 6/10/20, resident (R2), who resides in the assisted living section of the facility, had fifty dollars, a credit card, and pain medication reported missing. Law enforcement was notified of the incident.

LPA's interviewed Terry, as well as requested pertinent documentation for both residents in care to be emailed to LPA Angela Hood.

At this time, deficiencies are not being cited.

A copy of this report has been emailed to the facility and the Executive Director was advised that a signed copy of the report shall be submitted to CCLD within 10 days of receipt of this report. Exit interview conducted.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: (650) 676-0390
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1