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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803601
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:40:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:OAKMONT GARDENSFACILITY NUMBER:
496803601
ADMINISTRATOR:DEL DOSSO, MELISSAFACILITY TYPE:
740
ADDRESS:301 WHITE OAK DRTELEPHONE:
(707) 538-1914
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:79CENSUS: 45DATE:
12/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Katelyn Ledesma and Mariele SorianoTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced at approximately 11:40 AM on 12/17/2021 to conduct a case management inspection. This inspection is a follow up to two death reports received by Community Care Licensing on 12/14/2021. LPA met with Health Services Director Katelyn Ledesma and interim administrator Mariele Soriano.

LPA reviewed documents for resident, R1, and resident R2. LPA obtained copy of hospice care plan for R1. LPA noted date of admission to hospice for R2.

No deficiencies cited during today's inspection.

Exit interview conducted with health services director and interim administrator. Copy of this report printed for licensee.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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