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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700796
Report Date: 09/30/2020
Date Signed: 09/30/2020 04:38:53 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 EAST SACRAMENTOFACILITY NUMBER:
342700796
ADMINISTRATOR:ERVIN, TERENCEFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 0DATE:
09/30/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Terry Ervin, Executive DirectorTIME COMPLETED:
05:00 PM
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On 09/30/2020 at approximately 1:00 PM Licensing Program Analyst (LPAs) Jasmine McCrory and Kevin Mknelly arrived and met with Terry Ervin, Executive Director, who assisted in conducting this inspection.

LPA toured Physical Plant, Food Service, Common Areas, Bedrooms, Bathrooms, Kitchen and Medication Storage. Fire extinguisher is current and First Aid fully stocked.

Kitchen was clean and good repair. Facility is prepared to provide (7) seven days of non-perishable and (2) two days of perishable food required for emergency shelter in place supplies through food stocks. Bedrooms are one bedroom or two bedroom design. Rooms inspected have appropriate items and are in good repair. Water temperatures in bedrooms were measured at 108.7 and 107 degrees Fahrenheit in two different locations.

LPA observed medication rooms where centrally stored medications and toxins will be kept, refrigerators, cabinets, and medication carts are locked as well. The medication room doors lock and are inaccessible to residents.

Facility will accept total capacity of 213 non-ambulatory elderly residents; in which 8 may be bedridden. Memory care unit was observed in this facility to be clean, safe, and secured. All common areas appear to be free from hazards, clean and in good repair. As of this date, the Department has received the fire clearance.

During this visit, this facility is in substantial compliance and meets the minimum requirements for a RCFE license.

Component III waived.

Exit interview held with Terry Ervin, Executive Director at approximately 4:30 PM and a copy of this report was given at the conclusion of the visit.

Application is pending further review.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCroryTELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020
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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