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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202772
Report Date: 07/03/2023
Date Signed: 07/03/2023 04:59:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/03/2023 04:59 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:OAKMONT OF SILVER CREEKFACILITY NUMBER:
435202772
ADMINISTRATOR:BAGHERI, TAYEBEHFACILITY TYPE:
740
ADDRESS:3544 SAN FELIPE ROADTELEPHONE:
(669) 288-5000
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:148CENSUS: 62DATE:
07/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Mary Ann Bangsal- Business Office DirectorTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPA) Ravi Patel and Simi Rai arrived unannounced to conduct an annual visit. and met with Mary Ann Bangsal Business Office Director.

During visit, LPAs toured the inside and outside of the facility. LPAs toured the facility kitchen and observed at least 2 days of perishable food supply and at least 7 days of nonperishable food supply. Sharps and medications were locked in secured areas. There was a first aid kit in the facility and secured areas for cleaning supplies and laundry detergents.

The facility common bathrooms had available soap, paper towels, and trash cans with lids. The showers had grab bars and textured floors with shower chairs. The water temperature in the bathroom sinks ranged from 108 -112F. Fire extinguisher were observed and were inspected on June 2023.

Facility smoke and carbon monoxide detectors were tested and found to be in functioning condition. LPA's inspected ten random rooms and ten out of ten rooms had available bedding, drawers, and functioning lights. LPAs reviewed facility records for eight staff and ten residents.

LPAs will return another day to complete annual inspection.

This report was reviewed with Business Office Director Mary Ann Bangsal. A copy of the report was provided.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Ravi PatelTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023
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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