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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 11:54:43 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:
11:16 AM
MET WITH:Terry ErvinTIME COMPLETED:
12:00 PM
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On February 17, 2022 at 11:16 AM Licensing Program Analyst (LPA) Chris Hopkins made an unannounced case management visit to follow up on complaint #27-AS-20211202124038 regarding Resident 1 (R1) update. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA was screened and then met with Executive Director Terry Ervin.

Executive Director stated that he has contacted Adult Protective Services (APS), the Ombudsman, Canhr Attorney, R1's POA, and POA's Attorney. APS, Canhr Attorney, and POA's Attorney have not gotten back to Executive Director as of today. APS did take the initial report filed by Executive Director and stated to Executive Director they would follow up with him. APS still has not followed up. LPA suggested to Executive Director to follow-up with APS. Executive Director did send a follow-up email to the POA's Attorney asking for an update while LPA was in the facility. Executive Director will update LPA once he receives an update.

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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