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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601969
Report Date: 06/01/2022
Date Signed: 06/01/2022 03:01:57 PM


Document Has Been Signed on 06/01/2022 03:01 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:OAK GARDENFACILITY NUMBER:
198601969
ADMINISTRATOR:LUIS EFREN AGUILARFACILITY TYPE:
740
ADDRESS:246 E. NEWMAN AVENUETELEPHONE:
(626) 358-8230
CITY:ARCADIASTATE: CAZIP CODE:
91006
CAPACITY:6CENSUS: 6DATE:
06/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Laura Aguilar - Administrator TIME COMPLETED:
12:00 PM
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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced plan of correction (POC) visit to follow up on deficiencies noted on 5/24/22. LPA met with Laura Aguilar Administrator and explained the reason for the visit.

On 5/24/22 LPAs Flores and Maldonado conducted an annual visit at the facility and cited the following deficiency:
Section CCR 87606(c) Care of Bedridden Residents -. On 5/24/22 LPAs observed 3 out of 6 residents, R1,R2,R3 have a bedridden status in their physician's report and facility does not have a bedridden fire clearance. On 6/1/22 LPA Flores reviewed physician's reports for R1,R2,R3 and have been updated by primary physician's to note ambulatory status to non-ambulatory. Deficiency cleared.


Exit interview was conducted with Laura Aguilar Administrator an a copy of this report was email for signature due to technical difficulties. A hard copy of the report will be place on file with signature.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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