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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002810
Report Date: 11/07/2024
Date Signed: 11/07/2024 03:55:18 PM

Document Has Been Signed on 11/07/2024 03:55 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:OAKS FAMILY CAREFACILITY NUMBER:
347002810
ADMINISTRATOR/
DIRECTOR:
MIN, OKGIFACILITY TYPE:
740
ADDRESS:9456 BLUE DIAMOND WAYTELEPHONE:
(916) 714-1796
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Okgi MinTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 11/7/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct an annual required inspection. LPA met with Administrator, Okgi Min, and stated the purpose of the visit. Upon arrival, there were 5 residents in care with 2 staff on duty.

LPA evaluated the physical plant to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Facility is licensed for 6 non-ambulatory residents, 2 of which maybe bedridden. Facility is also approved for 3 hospice residents. Facility has a sprinkler system and a pull alarm in place.

Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair at this time. Fence and gate were observed to be in good repair. Facility has a covered patio at the back equipped with outdoor furniture for outdoor activities. Room temperature was observed at 75 degrees F. LPA observed 5 bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. Facility observed 2 1/2 bathrooms. LPA measured the hot water temperature measured at 110 degrees F in the hallway bathroom. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Food supplies were observed to be adequately stored. Fire extinguisher observed in the kitchen/dining was last inspected on 7/30/24. Smoke and carbon monoxide detectors were observed, tested and operable at this time. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. Fireplace is screened and not being used.

Due to insufficient time, this annual visit will require a continuation visit.

Exit interview was conducted with the Administrator and a copy of this report was provided.
Stephen RichardsonTELEPHONE: (916) 263-4700
Arvin VillanuevaTELEPHONE: 916-208-0023
DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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