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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803998
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:50:45 PM


Document Has Been Signed on 12/12/2023 03:50 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:OAKMONT GARDENSFACILITY NUMBER:
496803998
ADMINISTRATOR:SORIANO, MARIELEFACILITY TYPE:
740
ADDRESS:301 WHITE OAK DRIVETELEPHONE:
(707) 921-1861
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:79CENSUS: 46DATE:
12/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Executive Director, Morgan HolienTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Christi Coppo and Licensing Program Manager (LPM) Victoria Bertozzi arrived unannounced to conduct a case management to follow up on facility's current lack of certified Administrator. Facility currently has 46 residents in care.

At approximately 1:30pm LPA, LPM, and Executive Director, Morgan Holien discussed proposed Administrator, John Beltz and additional items that are still needed. Executive Director agrees to provide the following by December 18, 2023:
  • Statement explaining how proposed Administrator will meet regulation 87405 Administrator Qualifications and Duties while working eight in person hours per week as identified in the LIC500 Personnel Record.
  • Board Resolution designating Administrator

LPA will follow up with Administrator Certification Unit regarding Executive Director's Administrator Certificate.

No deficiencies cited.

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023
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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