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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
496803998
Report Date:
09/13/2022
Date Signed:
09/13/2022 11:07:58 AM
Document Has Been Signed on
09/13/2022 11:07 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 GARDENS
FACILITY NUMBER:
496803998
ADMINISTRATOR:
SORIANO, MARIELE
FACILITY TYPE:
740
ADDRESS:
301 WHITE OAK DRIVE
TELEPHONE:
(707) 921-1861
CITY:
SANTA ROSA
STATE:
CA
ZIP CODE:
95409
CAPACITY:
79
CENSUS:
43
DATE:
09/13/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Morgan Holien
TIME COMPLETED:
11:30 AM
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LPA Leibert returns to facility this date for the purpose of amending the D page of the 9099(A) that was created on 9/8/2022.
SUPERVISOR'S NAME:
Carla Martinez
TELEPHONE:
(707) 588-5059
LICENSING EVALUATOR NAME:
David Leibert
TELEPHONE:
(707) 588-5086
LICENSING EVALUATOR SIGNATURE:
DATE:
09/13/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/13/2022
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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