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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700751
Report Date: 04/12/2022
Date Signed: 04/12/2022 05:16:41 PM


Document Has Been Signed on 04/12/2022 05:16 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OAKMONT OF CARMICHAELFACILITY NUMBER:
342700751
ADMINISTRATOR:KATHLEEN GILBEYFACILITY TYPE:
740
ADDRESS:4717 ENGLE ROADTELEPHONE:
(916) 483-3800
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:101CENSUS: 71DATE:
04/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kathleen Gilbey, Administrator TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following the receipt of (2) Incident Reports (LIC624). LPA met with Kathleen Gilby, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA 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;. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. Additionally, LPA was screened upon entering the facility.

The following was discussed:

Resident (R1) felt light-headed on 4/2/2022 and was sent to the emergency room due to low vitals. Resident returned the following morning with no medication changes. R1 was using portable oxygen at the time of being sent out.

Resident (R2) moved to facility in March 2022 with a diagnosis of Dementia. Resident was not previously living in a facility but at home. On 4/5/2022, resident was able to remove the window alarm and open the window in the activity room and climb out into the facility courtyard that is fenced. R2 was discovered in the courtyard at 8:00 am, approximately 15 minutes later. A follow up meeting was held with resident's family to discuss a better placement for resident. Resident was not injured other than minor skin tears during the incident. Administrator contacted LPA on 4/6/2022 in the afternoon.

It appears the facility acted promptly with both residents.

There are no deficiencies being issued today.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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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