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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881162
Report Date: 11/22/2021
Date Signed: 11/22/2021 03:50:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:OAKMONT OF CHINO HILLSFACILITY NUMBER:
361881162
ADMINISTRATOR:MEDRANO, JANETHFACILITY TYPE:
740
ADDRESS:14837 PEYTON DRIVETELEPHONE:
(909) 606-3010
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:170CENSUS: 127DATE:
11/22/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:47 PM
MET WITH:Janeth MedranoTIME COMPLETED:
03:51 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for a required annual inspection, with an emphasis on the infection control domain. LPA met with Janeth Medrano who confirmed there are no active and/or suspected Covid-19 cases in the facility.

The facility submitted a mitigation plan to Community Care Licensing (CCL) to mitigate the spread of COVID-19 in the facility. Single entry point to the main lobby has a sign-in policy for universal entry screening. The facility also documents daily temperature and COVID-19 symptom checks for all visitors while residents are subject to routine symptom screening and regular observations for any change in condition. LPA observed all staff are properly fitted with face coverings. Continued weekly routine testing for staff is still observed.

LPA Bueno and Administrator Medrano toured the facility inside and out. Medrano verified that the smoke and carbon monoxide detectors were last tested on 10/22/21 and another test is scheduled on 11/23/21. Fire alarms and fire extinguishers are maintained and monitored by an outside vendor. LPA and Administrator viewed a fire extinguisher tag showing that last inspection date of 12/3/20. Hand sanitizer dispensers were observed throughout the facility, mostly situated by the elevators and door to common areas. Medrano confirmed the facility has an adequate supply of cleaning and disinfectant provisions.

Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed, and a copy of this report was also provided to the Administrator at the conclusion of the inspection.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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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