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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006224
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:42:56 PM

Document Has Been Signed on 11/05/2024 04:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:OAKMONT OF FULLERTONFACILITY NUMBER:
306006224
ADMINISTRATOR/
DIRECTOR:		SCHROEDER, LINDSAYFACILITY TYPE:
740
ADDRESS:433 W. BASTENCHURY ROADTELEPHONE:
(714) 869-1940
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 152CENSUS: 101DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Executive Director Maria KautenTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On November 5, 2024, at 8:45am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Concierge Jessica Ramirez. Executive Director (ED) Maria Kauten arrived the facility around 11:00am.

The facility is licensed to operate for one hundred fifty-two (152) nonambulatory residents of which eight (8) may be bedridden and have a hospice waiver for fifteen (15) residents. The facility is a three story structure and consists of the following: one hundred and one (101) resident bedrooms, nine (9) offices, one hundred and ten (110) bathrooms, living area, two dining areas, bar and lounge, TV room, kitchen, bistro, great area, theater room, fitness center, massage room, general outdoor patio area, outdoor dining courtyard, dog park, and a memory care outdoor patio area.

LPA Kim toured inside and outside of the physical plant with Business Office Director Laura Britain and Health Service Director Jhoana Salmi. There were no obstructions on the premises. There are two small fountains in the general outdoor courtyard and a small fountain in the Memory Care Courtyard. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, a chair, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The following Resident’s rooms were inspected: Resident Room 105, Resident Room 115, Resident Room 119, Resident Room 212, Resident Room 225, Resident Room 229, Resident Room 231, Resident Room 307, Resident Room 315, and Resident Room 323. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 110.3 degrees F to 113.9 degrees F. A comfortable temperature of 72 degrees F was maintained in the facility.

Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: OAKMONT OF FULLERTON
FACILITY NUMBER: 306006224
VISIT DATE: 11/05/2024
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LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the kitchen and staff emergency work room. The facility has twenty-one (21) fire extinguishers that were charged, mounted throughout the facility, and serviced on November 5, 2024.

During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were inspected by Calbuilding Systems on October 17, 2024. A working telephone (714-869-1940) and an internet capable devices for teleconferencing purposes remains available. LPA observed the facility Evidence of Liability Insurance was effective 12/31/2023 and expires on 12/31/2024.

LPA Kim conducted an audit of ten (10) resident files (R1-R10), ten (10) staff files (S1-S10), and medication and medication administration record were all in order and complete. LPA Kim conducted five (5) staff interviews and four (4) resident interviews.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Executive Director Maria Kauten.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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