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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 12/10/2023
Date Signed: 12/11/2023 07:34:11 AM


Document Has Been Signed on 12/11/2023 07:34 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:
12/10/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maria EstradaTIME COMPLETED:
11:45 AM
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On 12/10/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a Plan of Correction visit. LPA met with Facility Designated Representative (FDR), Maria Nelina Estrada and explained the purpose of the visit. There were two other staff members were present at that the facility, Facility Designated Administrator (FDA), Maria Linda Estrada and Celina Estrada.

Current census was 10.

The purpose of this visit was to follow up on the Plan of Correction that was due on 12/09/2023 from a prior Case Management visit conducted on 12/09/2023.

LPA reviewed the Plan of Correction to ensure that were was sufficient staffing at this time. Based on LPA observation and records review this plan of correction has been cleared.

The Plan of Correction letter was provided during this visit.
An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2023
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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