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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701121
Report Date: 04/24/2024
Date Signed: 04/24/2024 03:45:33 PM


Document Has Been Signed on 04/24/2024 03:45 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:OAKMONT OF EAST SACRAMENTOFACILITY NUMBER:
342701121
ADMINISTRATOR:KATHLEEN GILBEYFACILITY TYPE:
740
ADDRESS:5301 F STREETTELEPHONE:
(916) 905-2400
CITY:EAST SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:214CENSUS: 138DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Kathleen GilbeyTIME COMPLETED:
02:46 PM
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On 04/24/2024 at 8:28 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator Kathleen Gilbey and explained the purpose of the visit. Administrator Certificate # 6059719740 expires on 05/19/2025. The current census is 138.

LPA Lee and Marketing Director Janae Fernandez inspected the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA Lee and Marketing Director also toured both the assistant living and memory care. LPA Lee observed two movie theaters, activity room, wellness cove, bar and lounge, private dining, fitness room, salon, massage room, activity rooms, wine cellar and media ballroom. LPA Lee observed sufficient lighting throughout the facility. LPA observed the facility to be clean and in good repair. LPA observed 10 residents’ rooms and they are equipped with the required furniture. LPA Lee and Marketing Director observed resident room 333 had a very strong urine odor. There are no bodies of water present.

LPA measured the water temperature, temperature measured at 113.1 degrees F which meets the 105–120-degree Fahrenheit regulation. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies.

LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Grab bars awere observed to be stable and in good repair at this time.
Continued LIC 809-C
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OAKMONT OF EAST SACRAMENTO
FACILITY NUMBER: 342701121
VISIT DATE: 04/24/2024
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 Smoke and carbon monoxide detectors are in compliance with fire safety. Multiple fire extinguisher is located throughout the building in both assistant living and memory care building and was last serviced on 04/12/2024. Facility thermostat observed at 72 degrees Fahrenheit. LPA Lee observed toxins kept locked and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed and compared 3 medication administration record (MAR) along with residents’ medications and it was complete. The first aid kit was checked and contained all the required components. LPA Lee checked and tested 5 residents pendant and it was observed that facility staff came to check on those 5 residents under 5 minutes. LPA Lee inspected the two elevator in the building and it is in good repair and is current and will expire on 08/23/2024. LPA Lee also inspected the exhaust hood and is in good repair. Last service date was on 02/15/2024 and an upcoming service date is scheduled for 06/2024. LPA Lee requested residents and staff files for review. LPA Lee reviewed 6 resident files and 5 staff files, and they were complete and organized.

The following documents were given to LPA during today's visit.
(1) LIC 308 Designation of Administrative Responsibility
(2) LIC 610 Emergency Disaster Plan
(3) Proof of Current Liability Insurance
(4) Current LIC 500

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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