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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415601178
Report Date: 06/27/2024
Date Signed: 06/27/2024 04:06:20 PM


Document Has Been Signed on 06/27/2024 04:06 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 BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:OAKMONT OF BURLINGAMEFACILITY NUMBER:
415601178
ADMINISTRATOR:MORGAN, OREISHAFACILITY TYPE:
740
ADDRESS:1818 TROUSDALE DRIVETELEPHONE:
(650) 692-2805
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:97CENSUS: 79DATE:
06/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Oreisha MorganTIME COMPLETED:
04:30 PM
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On 6/27/2024 LPA Grace Donato made an unannounced pre-licensing visit to the facility. LPA met with Executive Director, Oreisha Morgan. LPA explained the purpose of the visit.

LPA toured the facility including random resident rooms, common areas & kitchen. The passageways were free of obstruction. Residents currently engaged in different activities. The residents have adequate amount of linens and all personal belongings are intact. While touring the facility it was observed that the room temperature was at 72 deg F. Hot water was also tested in the bathrooms and the temperature was 110 deg F. Carbon monoxide monitor is working properly. All fire extinguishers are scheduled for maintenance on 7/5/2024. Additional evacuation chairs in stairwells will be added. Client bathrooms were observed to be in good repair equipped with grab bars and non-skid floors. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Medication is audited monthly by the Resident Care Director.

Five client records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs.

Facility is clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. No citations are issued. Component III is conducted on this day.

No deficiencies are cited at this time. Report is reviewed and a copy is provided.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
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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