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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850169
Report Date: 06/23/2022
Date Signed: 06/23/2022 05:31:00 PM


Document Has Been Signed on 06/23/2022 05:31 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,
, CA



FACILITY NAME:OAKMONT OF CAMARILLOFACILITY NUMBER:
565850169
ADMINISTRATOR:BERARD, MARTHAFACILITY TYPE:
740
ADDRESS:305 DAVENPORT STREETTELEPHONE:
(805) 738-3600
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:150CENSUS: 80DATE:
06/23/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:11 PM
MET WITH:Martha BerardTIME COMPLETED:
05:35 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced POC visit to follow up on deficiencies cited during a Case Management visit conducted on 06/14/2022. LPA arrived at the facility at 04:11PM and met with Administrator Martha Berard. Entrance interview conducted.

During today's visit, LPA spoke with Administrator at 4:15PM, toured the facility with Administrator at 04:26PM and tested the delayed egress in the Memory Care unit at 04:33PM. Delayed egress was functional at the time of the visit. Plan of Correction (POC) was cleared during today's visit. Additionally, LPA received a copy of Resident #1 (R1)'s reappraisal during today's visit. POC cleared.

Exit interview was conducted with Administrator Martha Berard. Report was provided via email.
SUPERVISOR'S NAME: TELEPHONE:
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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