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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002205
Report Date: 09/13/2022
Date Signed: 09/13/2022 04:45:05 PM


Document Has Been Signed on 09/13/2022 04:45 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OAK GARDEN SENIOR RESIDENCEFACILITY NUMBER:
347002205
ADMINISTRATOR:ANTON, TEOFILFACILITY TYPE:
740
ADDRESS:6707 SUN DOWN COURTTELEPHONE:
(916) 944-0774
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Teofil Anton, AdministratorTIME COMPLETED:
02:30 PM
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On 09/13/2022 Licensing Program Analyst (LPA) Jacob Williams arrived unannounced to conduct a Required 1 Year inspection. LPA met with Administrator Teofil Anton and explained the purpose of the visit. Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; upon entry LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by staff upon entering the facility.

LPA and staff toured the facility together. LPA found facility to be odor-free and in good repair. Areas inspected include but are not limited to the following: Kitchen, living room, dinning area, resident bedrooms and bathrooms and backyard. LPA observed sharps, toxins and medications to be locked and inaccessible to residents in care. LPA observed there to be an adequate supply of 7 day nonperishable food items and 2 day perishable food items. LPA found resident bedrooms to have sufficient lighting and required furniture. LPA observed grab bars and nonskid mats in the resident bathrooms. LPA observed emergency exit paths to be free of barriers. LPA observed a sufficient supply of clean linens. Facility has a sufficient supply of PPE. LPA reviewed infection control procedures with Administrator and found facility to be in compliance.

As a result of today's visit, there are no deficiencies being cited. Exit interview conducted and a copy of report left at facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob WilliamsTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2022
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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