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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803998
Report Date: 06/10/2022
Date Signed: 06/10/2022 02:40:00 PM


Document Has Been Signed on 06/10/2022 02:40 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
CCLD Regional Office, 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: 41DATE:
06/10/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Katelyn Ledesma and Morgan HolienTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced to conduct a Post-Licensing Inspection and met with Executive Director, Morgan Holien and Health/Wellness Director Katelyn Ledesma. LPA was greeted by staff and asked to screen for COVID. Proof of vaccination was requested. Facility is 3 stories and contains both assisted living and independent living. Facility does not currently admit residents with a diagnosis of dementia.

LPA toured building and grounds which were clean and in good repair. Staff were observed wearing masks. All staff are vaccinated and boosted if eligible. All residents are vaccinated and boosted if eligible. Facility does not currently conduct surveillance testing. LPA and director discussed infection control plan which facility plans to submit later this month.

Medications are centrally stored and locked making them inaccessible to residents. Toxins are secured and inaccessible to residents. Fire extinguishers were last inspected in December of 2021. LPA observed fire alarm/sprinkler system throughout the facility. Facility has the necessary personal protective equipment (PPE) to support a resident in isolation. All bedrooms are private therefore residents could isolate in their own bedrooms if necessary. Resident bathrooms contain necessary grab bars and non-slip floors/mats.

LPA and director discussed Guardian and association process.

No deficiencies observed during today's inspection.

Exit interview conducted with Health/Wellness Director . LPA was unable to print, report was emailed to Executive Director directly during the visit before leaving the facility.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
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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