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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002205
Report Date: 09/09/2024
Date Signed: 09/09/2024 11:39:15 AM


Document Has Been Signed on 09/09/2024 11:39 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 5DATE:
09/09/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Teofil AntonTIME COMPLETED:
09:00 AM
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An informal conference was conducted on Monday September 9, 2024, via Microsoft Teams. The purpose of this informal conference meeting is to discuss deficiencies discovered during annual inspection conducted on July 11, 2024. Present in the meeting is Licensing Program Manager (LPM) Anthony Perez, Licensing Program Analysts (LPAs) Cassie Yang and Cassandra Mikkelson, and Licensee, Teofil Anton.

The informal conference process was explained during this meeting.

The facility was cited under the following regulations: fire safety, storage space and criminal record clearance.

The licensee was informed any further citations may result in an elevation to a formal non-compliance conference, which could lead to a referral to the Department's legal division for possible revocation of license.

Issues discussed during the meeting were:
· Staffing
· Inspection Authority
· Plan for garage/storage room

Technical Support Program was offered but denied by Licensee. At this time, the Department agreed to monitor facility as needed to ensure facility remains in compliance.

No deficiencies cited.

Exit interview conducted. Informal meeting concluded and a copy of report will be emailed. Facility Representative Signature is expected to be signed and returned to LPA by close of business, 9/9/2024.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024
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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