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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202737
Report Date: 04/08/2022
Date Signed: 04/08/2022 05:04:45 PM


Document Has Been Signed on 04/08/2022 05:04 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
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202737
ADMINISTRATOR:FLAVIO SILVAFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: DATE:
04/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Flavio SilvaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced annual required inspection to focus on infection control. LPA met with Executive Director, Flavio Silva.

On 03/24/2022, LPA began the annual inspection during the pre-licensing visit for #435202818. During visit, LPA toured the facility inside and outside. LPA observed the front entrance of the facility to include posters of required mask. Facility has a central entry point and symptom screening area for all visitors and staff. Hand sanitizer is made available. All fire exit routes were free and clear of obstructions.

Bathrooms observed to be supplied with hygiene products and paper supplies. Hand washing signs were posted in bathrooms. Foot operated trash can with lid observed. LPA observed facility to have enough PPE supplies. Facility disinfect and sanitize high touch surfaces daily and as needed. Social distancing signs was observed. Staff are N95 fit tested. All staff are fully vaccinated and boosted, if eligible. All staff observed to be wearing a mask. LPA reviewed facility's policies and procedures for isolation. Facility has a mitigation plan in place to prevent the spread of COVID-19.

During visit on 04/08/2022, LPA toured the common areas, assisted living dining, memory care dining, and bathrooms. LPA observed residents in memory care to be socially distanced during lunch.

LPA informed Administrator to submit Infection Control Plan to CCLD by 06/30/2022 and review PIN 22-13-ASC.

No deficiencies cited during today's visit per California Code of Regulations, Title 22.

This report was reviewed with Flavio Silva and a copy of this report was provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
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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