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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881162
Report Date: 09/14/2022
Date Signed: 09/14/2022 01:51:38 PM


Document Has Been Signed on 09/14/2022 01:51 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
SAN BERNARDINO, 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: 115DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Janeth MedranoTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Natalie Ibarra made an unannounced visit to conduct an annual inspection, with emphasis on infection control. LPA met with Administrator Janeth Medrano and explained the purpose of today’s visit. Administrator accompanied LPA on a tour of the facility.

LPA Ibarra toured the facility and made observations pertaining to the facility’s infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPEs. The entrance of the facility has a check in process for visitors that includes a vaccination verification/negative COVID test check, a temperature check, and a symptom check. The residents have hand sanitizer available throughout the facility, and the bathrooms were stocked with hand soap and paper towels. LPA Ibarra inspected the facility's Personal Protective Equipment (PPE) supply and observed facility has a thirty (30) day supply of PPE such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer. All residents and staff are practicing all other COVID-19 precautions, which minimize the risk of them contracting COVID-19.

No deficiencies were cited during today's visit.

An exit interview was conducted and a copy of this report was discussed and provided to the Administrator.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie IbarraTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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