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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804089
Report Date: 05/15/2024
Date Signed: 05/23/2024 09:41:23 AM

Document Has Been Signed on 05/23/2024 09:41 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/
DIRECTOR:		OKORO, SYLVESTERFACILITY TYPE:
740
ADDRESS:535 E. CHESTNUT STREETTELEPHONE:
(707) 409-5004
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 6CENSUS: DATE:
05/15/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sylvester OkoroTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
NARRATIVE
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At 9:00AM, Licensing Program Manager (LPM) Bethany Moellers and Licensing Program Analyst (LPA) Chris Arnhold held an Office meeting with Licensee Sylvester Okoro via Zoom to discuss administrative oversight concerns at the facility. On 02/29/2024, LPA Arnhold conducted an annual inspection at this facility and observed the appointed administrator was not present at the facility. LPA requested documentation to update the change in administrator. LPA did not receive the requested documentation.

The following documents were requested during this meeting:
Evidence of Liability insurance
Change of Administrator documentation
Board Resolution appointing new Administrator
LIC500
LIC308

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Sylvester Okoro and Appeal rights were given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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Document Has Been Signed on 05/23/2024 09:41 AM - It Cannot Be Edited


Created By: Christopher Arnhold On 05/15/2024 at 09:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: OCEANSIDE CARE HOME LLC
FACILITY NUMBER: 236804089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
HSC
1569.618(a)

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(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours.This requirement is
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Licensee to ensure a certified Administrator is present at the facility during normal business hours to ensure the facility is in compliance. Licensee to submit written plan detailing who and when Administrator
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not met as evidenced by:Based on observation and interviews conducted, the licensee did not comply with the section cited above. Administrator is not present in the facility a sufficient number of hours to ensure proper facility operation.
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will be present in the facility. Written plan shall be submitted to CCL by POC date of 5/16/2024.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bethany Moellers
LICENSING EVALUATOR NAME:Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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