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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700796
Report Date: 02/17/2022
Date Signed: 02/17/2022 11:54:08 AM


Document Has Been Signed on 02/17/2022 11:54 AM - 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, 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: 132DATE:
02/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Terry ErvinTIME COMPLETED:
11:15 AM
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On February 17, 2022 at 10:22 AM Licensing Program Analyst (LPA) Chris Hopkins made an unannounced case management visit to follow up on Fire Safety Inspection Request STD 850. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA was screened and then met with Assistant Executive Director Michael Clymo. Executive Director Terry Ervin later arrived.

LPA toured the facility with Assistant Executive Director, and there is no construction going on inside of the building. Executive Director stated that the STD 850 was not approved due to the fire hydrant in front of the building not functioning properly. While LPA was at the facility, LPA observed workers working on this fire hydrant. Residents will still have water, and they will not be impacted by this. Per Executive Director once the fire hydrant is fixed, the Fire Inspector will come out and approve the STD 850.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022
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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