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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803998
Report Date: 02/07/2025
Date Signed: 02/07/2025 05:05:08 PM

Document Has Been Signed on 02/07/2025 05:05 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:OAKMONT GARDENSFACILITY NUMBER:
496803998
ADMINISTRATOR/
DIRECTOR:
MORGAN HOLIENFACILITY TYPE:
740
ADDRESS:301 WHITE OAK DRIVETELEPHONE:
(707) 921-1861
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 79CENSUS: DATE:
02/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:28 PM
MET WITH:Gloria Albor, Business Operations ManagerTIME VISIT/
INSPECTION COMPLETED:
05:19 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management visit and was greeted by Gloria Albor, Business Operations Manager (BOM).

On 1/31/25 the facility submitted to CCL an Incident Report for resident (R1) indicating that on January 30, 2025 R1 was found on the floor in their room by caregiver and Med Tech. R1 was found to be breathing hard, presented as confused, and observed to have a bump on their head. Emergency Medical Services called and R1 was transported to the hospital emergency room. Facility reported that facility later received an email from resident's family member that R1 had passed away. Cause was unknown at the time.

Facility Administrator, Morgan Holien was not available at time of LPA visit. Health and Wellness Director (HWD), Jody Livingston also not available. LPA unable to gain clarification on the cause of death of R1 as Admin and HWD were not available. LPA requested documents for R1 from BOM: Care Plan, Charting Notes, and most current physician's report.

BOM does not have access to R1's documents so LPA requested facility send them to CCL by Monday, February 10,2025.

No deficiencies cited.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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