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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000443
Report Date: 08/14/2024
Date Signed: 08/14/2024 04:27:15 PM


Document Has Been Signed on 08/14/2024 04:27 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:OAKS PRIVATE HOME CAREFACILITY NUMBER:
347000443
ADMINISTRATOR:TABB, LYDIAFACILITY TYPE:
740
ADDRESS:7016 LINCOLN OAKS DR.TELEPHONE:
(916) 961-5232
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 6DATE:
08/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Lygia Chapman, AdministratorTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Lygia Chapman, to follow-up on a plan of correction made to the facility on 1/10/2024 to be completed on 1/11/2024.

During today's visit, LPA reviewed records for all six (6) residents residing at the facility. LPA observed that facility does not have any residents classified as bedridden. LPA cleared deficiency during today's visit.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024
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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