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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202818
Report Date: 04/08/2022
Date Signed: 04/08/2022 02:38:03 PM


Document Has Been Signed on 04/08/2022 02:38 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:
435202818
ADMINISTRATOR:SILVA, FLAVIOFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: DATE:
04/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Flavio SilvaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a follow-up pre-licensing visit from 03/24/2022. LPA met with Executive Director, Flavio Silva.
On 03/24/2022, the facility was cited a deficiency and technical violations under facility #435202737. Due to deficiency and technical violations, the facility was not ready to be licensed until a follow-up visit was conducted to observe correction.

During visit, LPA reviewed three resident's centrally stored medication logs and observed the deficiency to be corrected. LPA reviewed four personnel records and observed the technical violation to be corrected. Facility has a plan in place to complete remaining personnel records to include updated 1st Aid certification and health screening reports. LPA observed the facility's emergency non-perishable supplies to be up-to-date and technical violation to be corrected.

The deficiency and technical violations issued during previous visit are observed to be corrected.

No issues noted during this pre-licensing inspection.

LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

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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