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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804089
Report Date: 02/29/2024
Date Signed: 02/29/2024 11:00:42 AM


Document Has Been Signed on 02/29/2024 11:00 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:OCEANSIDE CARE HOME LLCFACILITY NUMBER:
236804089
ADMINISTRATOR:OKORO, SYLVESTERFACILITY TYPE:
740
ADDRESS:535 E. CHESTNUT STREETTELEPHONE:
(707) 409-5004
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:6CENSUS: 6DATE:
02/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Valesia ColeTIME COMPLETED:
11:15 AM
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At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a required 1-year annual inspection. LPA met with Administrator Valesia Cole and explained the purpose of this visit. LPA observed the administrator certificate is on the pending list and requested Licensee submit the required documents for a change of administrator.

LPA and Staff conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: resident bedrooms, staff room, bathrooms, kitchen and the common areas. LPA observed the facility to be at a comfortable temperature. LPA observed sharps, medications and toxins to be locked and secured. LPA observed the facility to have ample supply of linens, perishable and non-perishable foods. In areas toured, no immediate health, safety or personal rights violation was observed.

LPA conducted a file review for all six residents and three staff. LPA observed the required documents present on file. LPA and Administrator completed the CARE inspection tool and found the facility to be in compliance. No deficiencies observed.

LPA requested the following documents during visit. Documents to be submitted to CCL within 30 days of this visit.
LIC 500
LIC 308
Liability insurance
Change of Administrator documents

Exit interview conducted and a copy of the report was left with Administrator.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
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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