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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701272
Report Date: 10/04/2023
Date Signed: 10/04/2023 03:50:48 PM


Document Has Been Signed on 10/04/2023 03:50 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:OAKMONT OF LODIFACILITY NUMBER:
392701272
ADMINISTRATOR:MACKEDSY, SARAFACILITY TYPE:
740
ADDRESS:2905 REYNOLDS RANCH PARKWAYTELEPHONE:
(209) 310-1512
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:136CENSUS: 88DATE:
10/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Vice President of Operations Terry Evans, Representative for applicant Oakmont Senior Living of Lodi, OPCO LLC; Oakmont MG LLC, and Administrator Andrea Armstrong.TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Renee Campbell and LPA Victoria Brown, conducted an announced Pre-licensing visit on 10/04/2023 at 8:30am with Vice President of Operations Terry Evans, Representative for applicant Oakmont Senior Living of Lodi, OPCO LLC; Oakmont MG LLC, and the facility Administrator Andrea Armstrong. Administrator and Representative accompanied LPA’s on facility tour. As of today, the current census is 88 residents of which 7 are receiving hospice services, 76 are ambulatory, 12 are non ambulatory, and 0 are bedridden. The facility is a 96 bedroom, 100 bathrooms with a living room, dining room, kitchen, and laundry room. Residents have access to all areas.
File reviews were conducted for 7 residents. LPA also reviewed 3 staff files.

LPA measured the hot water in room 138 at 108 degrees Fahrenheit and room 246 at 107 degrees Fahrenheit.

The kitchen was observed in good condition with properly stored perishable and non perishable foods. Prepared foods were covered in the refrigerator. The refrigerator was at 39 degrees Fahrenheit and the freezer was at -2 degrees Fahrenheit.

LPA Campbell observed medications locked and properly stored. LPA observed no obstruction of emergency exits. Exit signs were in place as appropriate. Fire extinguisher located in the hallway was observed to be fully charged. First aid kit was observed to be present in the medication rooms and contained all required components at this time.

Component III conducted - There are no objections to licensure at this time. -Licensure pending.

An exit interview was conducted and a copy of this report was provided to Administrator Andrea Armstrong .

SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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