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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700796
Report Date: 10/04/2021
Date Signed: 10/05/2021 09:01:21 AM

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: 133DATE:
10/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:47 PM
MET WITH:Michael Clymo and Terry Ervin TIME COMPLETED:
04:48 PM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 10/04/2021 at 3:47 PM. LPA met with Michael Clymo and Terry Ervin and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

The facility is licensed for 214 non-ambulatory residents and has an approved hospice waiver for 8 residents. There are currently 133 residents who reside at this facility, and there 2 residents on hospice.

LPA Martinez toured the facility with Michael Clymo and Terry Ervin on 10/04/2021 at 4:00 PM.

The facility has one central screening entry point at the assisted living community. The facility has submitted a LIC 808 mitigation plan and has been approved. LPA Martinez reviewed the LIC 808 mitigation plan with Michael Clymo and Terry Ervin. The facility has a designated area for outside visit. The facility has covid-19 postings. The facility has hand sanitizer throughout the assisted living community. The facility common areas, bathrooms are sanitary and furnished at the assisted living community.

LPA Martinez will return at a later date and time to inspect the memory care community. There were no deficiencies observed or cited at this annual inspection visit. An exit interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
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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