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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701121
Report Date: 03/29/2022
Date Signed: 03/29/2022 03:14:42 PM


Document Has Been Signed on 03/29/2022 03:14 PM - 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:
342701121
ADMINISTRATOR:ERVIN, TERENCEFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 137DATE:
03/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Michael ClymoTIME COMPLETED:
03:35 PM
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On 3/29/22 at 1:25pm Licensing Program Analyst (LPA) Chris Hopkins arrived at Oakmont of East Sacramento for the purpose of conducting an unannounced Pre-Licensing inspection due to Change of Ownership. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA was screened for COVID-19 symptoms and temperature taken at front desk. LPA met with Assistant Executive Director Michael Clymo and together conducted a tour of the facility.

LPA inspected the kitchen, resident bedrooms, resident bathroom, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 110 degrees F, in assisted living unit and water temperature measured at 107 degrees F in the memory care unit, which meets the 105-120 degree Fahrenheit regulation. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies LPA observed centrally stored medications locked. Cleaning supplies kept locked in house keeping closet. The facility has an approved LIC 808 mitigation plan on file.

There were no deficiencies observed during today's Pre-licensing inspection.

Component III was conducted and completed during today's Pre-licensing inspection.

Exit Interview was conducted with Assistant Executive Director Michael Clymo and a copy of this report was provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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