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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202818
Report Date: 04/30/2024
Date Signed: 04/30/2024 07:58:36 PM


Document Has Been Signed on 04/30/2024 07:58 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
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FACILITY NAME:OAKMONT OF SAN JOSEFACILITY NUMBER:
435202818
ADMINISTRATOR:PAULA SPANEKFACILITY TYPE:
740
ADDRESS:917 THORNTON WAYTELEPHONE:
(408) 371-7100
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:92CENSUS: 60DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Christopher SchusterTIME COMPLETED:
03:30 PM
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On 4/30/24, LPA Grace Donato conducted an unannounced annual visit to the facility. LPA met with Interim Executive Director Christopher Schuster and explained the purpose of the visit..

LPA toured the facility including a random sample of resident apartments, common areas, and kitchen area. LPA observed residents doing exercises in the activity area. While touring the facility it was observed that the temperature was at 78 deg F. Hot water was also tested and the temperature was 110 deg F. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Facility has a sprinkler system. All fire extinguishers have been checked and current. Resident bedrooms and bathrooms were observed to be in good repair. LPA. There is adequate amount of food, 2 days for perishables and & 7 days non-perishable.

Five resident records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Facility accepts hospice residents and are in compliance with the required waiver requirements.

Medication review was done, and all medications are accounted for, and centrally stored medication records are updated.

LPA interviewed 5 residents and 4 staff. All residents stated that they are being well taken care of and enjoys the food. All staff are competent with regards to the care of the residents.

LPA received the following documents: Liability Insurance, LIC 308. Administrator certificate is pending for review.

No deficiencies cited today. Report is reviewed and copy is provided.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
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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