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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 12/06/2023
Date Signed: 12/06/2023 11:56:51 AM


Document Has Been Signed on 12/06/2023 11:56 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:OAKHAVENFACILITY NUMBER:
390303860
ADMINISTRATOR:MARIA LINDA ESTRADAFACILITY TYPE:
740
ADDRESS:725 EAST OAK STREETTELEPHONE:
(209) 465-2597
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY:15CENSUS: 10DATE:
12/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Maria Linda EstradaTIME COMPLETED:
11:30 AM
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On 12-6-23 at 10:22am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a plan of correction (POC) visit related to a previous case management visit from 11-29-23. LPA met with Administrator Maria Linda Estrada. Mental health personnel was also on sight during today's visit. Additionally, pest control company contracted by facility was on-site. LPA observed pest control servicing facility for bed bug treatment with expected follow up within approximately one week. LPA also reviewed pest control agreement which included scheduled treatments for bed bugs and instructions for residents in care and staff to be out of facility for approximately 4 hours. LPA conducted brief interview with Administrator and it was revealed that residents will be assisted to lunch off site. Additionally, LPA observed residents in care occupying a covered area in the parking lot area of the facility and assisted with medications by facility staff as scheduled. Resident to return to facility at 2:00pm today.

LPA cleared plan of correction during today's visit. An exit interview was conducted with Maria Linda Estrada and a copy of this report was provided to Maria.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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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