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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850169
Report Date: 09/01/2022
Date Signed: 09/06/2022 10:45:00 AM


Document Has Been Signed on 09/06/2022 10:45 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:OAKMONT OF CAMARILLOFACILITY NUMBER:
565850169
ADMINISTRATOR:FAYE, SAMFACILITY TYPE:
740
ADDRESS:305 DAVENPORT STREETTELEPHONE:
(805) 738-3600
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:150CENSUS: 80DATE:
09/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:16 PM
MET WITH:Bradlee Foerschner/Kailey VanderwallTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted a case management - incident visit for the purpose of addressing an incident LPA was made aware of while conducting an unrelated visit at the facility today. LPA met with Executive Director (ED) Bradlee Foerschner. Entrance interview conducted.

LPA was made aware of an incident which occurred overnight on the night of 08/30/2022-08/31/2022 involving alleged unauthorized entry to Resident #1 (R1)'s private room. During today's visit at approximately 04:55PM, law enforcement arrived at the facility to take a report. At the time of this report, LPA had not received a written report of this incident.

Due to time constraints, LPA will return at a later date to continue investigation into this incident.

Exit interview was conducted with ED Foerschner. A copy of the report was provided via email.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly DulekTELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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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