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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701014
Report Date: 06/16/2021
Date Signed: 06/18/2021 10:27:39 AM

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 LODIFACILITY NUMBER:
392701014
ADMINISTRATOR:PRYOR, JESSICAFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(949) 744-5200
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 0DATE:
06/16/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Corinne Shell, Regional Director TIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA)T. White conducted announced Pre-Licensing inspection on 6/16/2021 at 11:15am. LPA was allowed entry that will be licensed for a capacity of 136 non-abmbulatory residents, of which 8 residents may be bedridden. LPA met with Corinne Shell, Applicant who assisted with today’s inspection.

LPA toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed the kitchen area, dining room area, apartments, bathrooms, storage areas, activity rooms, outdoor areas, swimming pool, and laundry rooms. LPAs observed required furniture, and lighting throughout the facility. Applicant stated residents will provide their own furniture.

The hot water temperature was measured in apartments at 111.0, 117.1, and 119.2 degrees F.which is within the required range of 105-120*F. The temperature inside the facility measured on the facilities thermostat to be 72*F which is within the required range of 68-85*F. LPA observed the facility has alarms throughout the facility. LPA observed delayed egress in the memory care unit.

LPA observed facilities menu and activity calendar. LPA observed scheduled grocery list for facility non-perishable and perishables. Facility will order non-perishables and perishables food once facility is licensed.

First aid kit observed to be complete. LPA observed centrally stored medications area to be locked. LPA observed the fire extinguishers, smoke and carbon monoxide detectors throughout the facility. LPA observed the area where the staff and resident files will be locked and readily available for review.

Component III conducted - Licensure pending.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. An exit interview was conducted with Applicant and a copy of this report provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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