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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202737
Report Date: 02/26/2021
Date Signed: 03/03/2021 04:46:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202737
ADMINISTRATOR:HIGGINS, JOLIEFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 45DATE:
02/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jolie HigginsTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Karen Taku and Health Facility Evaluator Nurse Rebekah Bird-Wohlgemuth, conducted a virtual tele-visit via ZOOM, to provide technical assistance to prevent and mitigate the spread of COVID-19 within the facility. LPA met with Administrator Jolie Higgins.

During today's tele-visit the following recommendations were made to the facility:

1. Include additional temperature checks for staff off-going.

2. Place a sign in the elevator showing “Max capacity” or the like.

3. Place hand washing sign in Activity room, third floor bathroom and basement.

4. Provide disinfecting wipes and trash can with lid/pedal in break room.

5. Ensure staff follow instructions for contact/wet time on the label of disinfectant product.

This report was reviewed with the Administrator and a copy was provided via email for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Karen TakuTELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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