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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202898
Report Date: 09/17/2025
Date Signed: 09/18/2025 07:16:53 AM

Document Has Been Signed on 09/18/2025 07:16 AM - 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:
435202898
ADMINISTRATOR/
DIRECTOR:		HOLLY SUITERFACILITY TYPE:
740
ADDRESS:3544 SAN FELIPE ROADTELEPHONE:
(669) 200-2442
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 148CENSUS: 74DATE:
09/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Mary Ann Bangsal Business Office DirectorTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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 Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted and unannounced Required 1-year inspection visit and was met by Business Office Director (BOD) Mary Ann Bangsal and Maintenance Director (MD) Jaime Martinez. Executive Director/Administrator (ED/ADM) Minnie Lacson-Weber was not present due to prior commitment at the time of the visit.

The facility serves adults age 60 and over, capacity of 148 for ambulatory and non-ambulatory and hospice waiver for 15.

Upon entry to the facility at 1:10 p.m., LPA observed residents participating on the going activity, some of the residents were in the coffee area, some were in the dining area. LPA observed that hallways, walkways and emergency exits were free from debris and obstruction.

LPA was accompanied by the Maintenance Director (MD) while conducting the inspection. LPA inspected the interior of the facility, including but not limited to the entryway, common room, dining room, kitchen and emergency food storage, emergency water storage, laundry room, resident rooms in the assisted and memory care area.

LPA conducted an inspection of the facility kitchen and met with executive chef (EC). EC accompanied LPA to the walk-in refrigerator and freezer and the entire kitchen area including the prep area. LPA observed that the refrigerator temperature is at 32 degree F and freezer is at -4 degree F. LPA observed the kitchen to be in sanitary despite of the flurry of activity while preparing for an event. No resident is allowed in the kitchen. LPA observed that the dining area is kept sanitary and organized and open for residents to use.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CREEK
FACILITY NUMBER: 435202898
VISIT DATE: 09/17/2025
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The facility has emergency drinking water supply and emergency food supply that are ready to eat in case of emergency. The facility has 2 days of perishable food and 7 days of non-perishable food.

LPA inspected the memory care area and met with the Memory Care Director (MCD). MCD accompanied LPA in inspecting memory care resident rooms. LPA observed rooms were sanitary, and organized, no sharps or chemicals accessible to residents in care, bathrooms were equipped with grab bars and non-slip flooring. The rooms have ample storage to store personal belongings. The room temperature measured at 75 degree F. The memory care area exits is equipped with delayed egress and working audible alarms. The water temperature measured at 105 to 109 degree F. At the time of the inspection LPA observed 3 resident were quarantined in the memory care unit.

LPA inspected the assisted living area with MD and inspected random residents room. LPA observed the apartments were organized and sanitary. The bathrooms are equipped with grab bars and non skid flooring. The rooms are equipped with small kitchen appliances such as microwaves and refrigerators. Storage area for the resident's personal belongings. The water temperature measured at 105 to 109 degree F.

The facility is equipped with fire alarm system, water sprinkler, carbon monoxide and smoke alarm. The fire system is connected to the fire department. The facility has fire extinguisher that are strategically located on each floor and a main fire hose outside.

LPA reviewed the facility resident administrative file and found the files to be complete and updated. The facility maintains the centrally stored medication logs for the residents would require further review. Disaster training will need to be reviewed at a later date.

LPA reviewed the staff file such as but not limited to 1st Aid/CPR training certificates, background, personnel report, health screening and training. LPA verified that the record are complete and up to date.

Due to time constraint the annual inspection will be continued at a later date. No citations were issued during today's visit based on California Code of Regulation (CCR) Title 22. An exit interview was conducted with Business Office Director Mary Ann Bangsal and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC809 (FAS) - (06/04)
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