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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803998
Report Date: 01/26/2022
Date Signed: 01/27/2022 11:03:54 AM


Document Has Been Signed on 01/27/2022 11:03 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:OAKMONT GARDENSFACILITY NUMBER:
496803998
ADMINISTRATOR:SORIANO, MARIELE'FACILITY TYPE:
740
ADDRESS:301 WHITE OAK DRIVETELEPHONE:
(707) 921-1861
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:79CENSUS: 45DATE:
01/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Interim Administrator, Melinda WardTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Erik Gonzalez-Campos arrived announced, to conduct a Pre-Licensing Inspection and met with interim administrator, Melinda Ward. LPA spoke with current administrator Mariele Soriano who agreed to have LPA perform inspection and Component III with Melinda Ward. Facility currently has 45 residents in assisted living and 79 in independent living

LPA and interim administrator toured the facility and grounds. Facility is a three story building with 56 assisted living apartments and 107 independent living apartments. Resident bedrooms have required furnishings, such as a dresser, night stand, lamp and bed linens. Bathroom showers have non-skid mats and grab bars for safety. LPA confirmed that contents of the facility First Aid Kit were sufficient. LPA was unable to measure water temperature but facility has a history of compliance, water temperature last measured at 109.8 and 114.3 degrees Fahrenheit. Facility has sufficient items used for cooking and eating. Facility locks medication in a locked medication room. Assisted living resident files are stored in the medication room. Staff files are kept in the business manager's office. Cleaning supplies and toxins were observed on locked cleaning carts. Perishable and non-perishable foods observed per regulation. Interim administrator indicated that facility underwent internal audit of resident files in preparation for change of ownership.

Facility received an approved fire clearance dated November 17, 2021 that allows for 69 non-ambulatory residents and 10 bedridden residents. Facility has space indoors and outdoors for client activities.

Component III reviewed with interim administrator.

LPA will notify Application Unit so application process may proceed.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2022
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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