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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005427
Report Date: 08/24/2023
Date Signed: 08/25/2023 08:13:38 AM


Document Has Been Signed on 08/25/2023 08:13 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:OAKMONT OF FOLSOMFACILITY NUMBER:
347005427
ADMINISTRATOR:CLYMO, MICHAELFACILITY TYPE:
740
ADDRESS:1574 CREEKSIDE DRTELEPHONE:
(916) 817-4500
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:88CENSUS: 69DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Michael Clymo, Executive DirectorTIME COMPLETED:
04:00 PM
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On 8/24/2023 LPA Tryon visited the facility to conduct an annual visit using the CARE Tool. LPA was greeted by Executive Director Michael Clymo.
LPA toured the facility with Mr. Clymo including common areas, resident apartments, bathrooms, hallways, dining room, kitchen, storage areas, courtyard/outside area.
The facility was found to be clean, nicely decorated and furnished, very spacious with plenty of room for various activities.
Food supplies were reviewed and appear to be more than adequate to meet the requirement of 2 days perishable and 7 days non-perishable. Food appears to be stored appropriately, to be of good quality and appearance. Cleaners and potentially harmful substances are stored away from food and secured. Medications are centrally stored, logged and locked.
Hot water tested within range of 105 to 107 degrees F. at 110 degrees F.
Staff files w
LPA reviewed 7 resident files and required documentation appears to be present. Staff have criminal record clearance, health screenings/TB clearance, appropriate training.

LPA reviewed the CARE tool with Mr. Clymo.

LPA requested updated copies of Administrator Certificate, Liability Insurance policy.

At this time, the facility appears to be in substantial compliance with the regulations.
No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023
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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