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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700751
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:01:26 PM


Document Has Been Signed on 05/02/2022 02:01 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: 74DATE:
05/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Kathleen Gilbey, Administrator/Executive Director TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Kathleen Gilbey, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE): N95 mask. The facility is licensed for 101 non-ambulatory residents and have a hospice waiver for 12 residents. There are currently 3 residents on hospice.

LPA and the Executive Director toured the interior and exterior of the facility of the Assisted Living Unit (ALU) and Memory Care Unit (MCU) including the medication room, dining room, activity room and common areas. Also observed in the ALU area were the theater, library, salon, massage and physical therapy room.

LPA observed the facility to be clean, in good repair and to be odor free and the bathrooms to have paper towels, soap and trash cans with lids. Facility to re-post hand-washing signs by each sink. Business Office Director maintains staff fingerprint associations regularly. Facility is limiting staff room to 2 staff at a time and windows are left slightly open. Fire extinguishers observed throughout and to have been last serviced on 8/6/2021. LPA observed 2+day perishable and 7+day non-perishable food in the kitchen and locked toxins in the laundry rooms. Facility has emergency lighting and a back-up generator. LPA observed hand sanitizers throughout and required postings displayed. Discussed vaccination protocols of residents and staff and visitation protocols in place. Booster #2 clinic scheduled for 5/12/22.

LPA requested a copy of LIC308, LIC500 and current liability insurance be emailed to CCLD by 5/9/2022.

There were no deficiencies observed during today's inspection. 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: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
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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