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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700751
Report Date: 08/30/2022
Date Signed: 08/30/2022 03:55:52 PM


Document Has Been Signed on 08/30/2022 03:55 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:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Kathleen Gilbey, Administrator TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to issue a related deficiency to complaint # 25-AS-20211027124047 that was opened/closed under the facility's prior license that was open through 5/3/2021. Complaint findings for this complaint were issued on April 12, 2022. LPA met with Administrator, Kathleen Gilbey, 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 community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

This report was created to document today's inspection under the current license and that a $500.00 penalty is being issued to the facility pursuant to Health and Safety Code section 1569.49(c)(1) - a violation that resulted in the injury or illness of a resident. The violation occurred on July 2018.

There are no deficiencies issued on this report.

Exit interview. Copy of report left with Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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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