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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700751
Report Date: 05/19/2021
Date Signed: 05/19/2021 11:10:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:OAKMONT OF CARMICHAELFACILITY NUMBER:
342700751
ADMINISTRATOR:CONDIE, NATHANFACILITY TYPE:
740
ADDRESS:4717 ENGLE ROADTELEPHONE:
(916) 483-3800
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:101CENSUS: 64DATE:
05/19/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kathleen Gilbey TIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Keosavang and Williams arrived at the facility unannounced on 05/19/2021 to conduct an Annual/Random Inspection utilizing the infection control domain. LPAs met with Administrator, Kathleen Gilbey, and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPAs were screened by facility staff upon entering the facility.

LPAs and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, three (3) bathrooms, kitchen, and staff lounge. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

LPA requested for documents to be sent to Community Care Licensing by 5/24/2021.
  • Personnel Report LIC 500
  • Facility Floor Plan LIC 999
  • Fire Clearance
  • Administrator's Certificate
  • Control of Property
  • Emergency Disaster Plan LIC 610 E

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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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