342700796-10-7-2021-27-AS-AMAZ-C7KMJT-20211007093941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700796
Report Date: 10/07/2021
Date Signed: 10/07/2021 09:39:44 AM

COMPREHENSIVE INSPECTION

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 SACRAMENTO		FACILITY NUMBER:	342700796
ADMINISTRATOR:	ERVIN, TERENCE		FACILITY TYPE:	740
ADDRESS:	5301 F STREET		TELEPHONE:	(916) 905-2400
CITY:	EAST SACRAMENTO	STATE: CA	ZIP CODE:	95819
CAPACITY:	214	CENSUS: 133	DATE:	10/07/2021
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Michael Clymo		TIME COMPLETED:	09:45 AM

NARRATIVE

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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 10/07/2021 at 8:20 AM. LPA met with Michael Clymo 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 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 on 10/07/2021 at 9:00 AM.

The facility has one central screening entry point at the memory care community. The screening consist of temperature checks and Covid-19 precautionary questions. The facility has submitted a LIC 808 mitigation plan and has been approved. The facility has a designated area for outside visit. The facility has covid-19 postings. The facility has hand sanitizer at the main screening entry area. The facility common areas and bathrooms are sanitary.. The facility's common furniture is spaced 6 feet apart. The facility's last fire inspection was on 07/21/2021, and the fire extinguishers are in good repair. The facility also conducted a fire drill in July of 2021.

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-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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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