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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201085
Report Date: 01/08/2025
Date Signed: 01/08/2025 12:29:24 PM

Document Has Been Signed on 01/08/2025 12:29 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:OAKMONT OF CONCORDFACILITY NUMBER:
079201085
ADMINISTRATOR/
DIRECTOR:		SOR, KIM SFACILITY TYPE:
740
ADDRESS:1401 CIVIC COURTTELEPHONE:
(925) 798-4004
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 121CENSUS: 92DATE:
01/08/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Kim Sor, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 1/08/25, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a case management visit due to receiving a LIC624 regarding an incident that occurred on 12/25/24 when a staff (S1) member working in the memory care unit placed tape on a resident's (R1) mouth to stop her from talking. LPA met with Kim Sor, Executive Director and explained the purpose of the visit.

LPA reviewed S1's personnel file. S1's employment with the facility suspended on 12/25/24 and then formally terminated on 12/31/24. Facility staff conducted a full investigation into the incident. S1 is deemed ineligible for re-hire. S1 admitted that she did place tape on the residents mouth to prevent her from talking. S1 expressed remorse for her actions.

LPA interviewed S2 who stated that R1 was evaluated after the incident and appeared to not have been adversely affected by the incident. S2 also stated that S1 was immediately suspended at the time of the incident and later terminated.

LPA toured the memory care unit with S2 and observed that residents were well dressed, clean and appeared well cared for. Staff were observed to be engaging with the residents, including R1, in a variety of activities.

Facility conducted a training on Resident Rights on 12/25/24 and 12/30/24 as a reminder for staff to treat the residents with respect.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.



SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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