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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095920142
Report Date: 08/07/2024
Date Signed: 08/07/2024 12:24:58 PM

Document Has Been Signed on 08/07/2024 12:24 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:OAK LANE CENTERFACILITY NUMBER:
095920142
ADMINISTRATOR/
DIRECTOR:
OKOLO, SAFARATUFACILITY TYPE:
772
ADDRESS:6840 OAK LANETELEPHONE:
(530) 888-5000
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 12CENSUS: 0DATE:
08/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator Safaratu OkoloTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Lavinia Muscan met with applicant, Safaratu Okolo, to conduct an announced Pre-Licensing visit. Applicant holds a current administrator certificate (# 7025530735 with expiration date 6/20/2025). The facility currently has 0 clients.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. Facility inspection is done for these areas but not limited to six (6) client bedrooms, one (1) staff room, one (1) nurses office, six (6) bathrooms, storage area, outside area and laundry area . Bathrooms and bedrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher is ready for emergency use. Facility was approved for 12 non-ambulatory residents. Water temperature read within regulation.

Component III for ARF was completed with Administrator/Applicant Safaratu Okolo during today's visit. LPA will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components.

Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was provided to the facility. Exit interview conducted.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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