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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097005553
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:46:39 AM


Document Has Been Signed on 08/22/2024 10:46 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:OAK CREEK SENIOR CAREFACILITY NUMBER:
097005553
ADMINISTRATOR:DR. BENJAMIN FOULKFACILITY TYPE:
740
ADDRESS:2908 TAM O'SHANTER DRIVETELEPHONE:
(916) 939-0962
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: 4DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Jennifer HinchTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced on 8/22/24 to do a case management visit. LPA met with Administrator Jennifer Hinch and explained the purpose of the visit.

Based on facility file review there appears to be some association discrepancies to Licensee facilities that needs investigating. LPA requested the following: STAFF ROSTER FOR Oakridge Senior Care, Oak Haven Senior Care, Oak Hill Senior Care, Village Oaks Senior Care LLC, Oak Grove Senior Care, Oak Creek Senior Care and El Dorado Hills Senior Care with ID attached to each staff member. Additionally, LPA requested a copy of the Administrator Certificates for each facility mentioned and the LIC 308 to be emailed by 8/26/24.

At this time, this case in under review and department will follow up as needed.

No citations were issued per Title 22 Regulations.

Exit interview conducted and copy of the report left at facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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