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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 12/11/2023
Date Signed: 12/11/2023 03:54:59 PM


Document Has Been Signed on 12/11/2023 03:54 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: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:
12/11/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria Linda EstradaTIME COMPLETED:
04:00 PM
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On 12/11/23 at 1:15pm Licensing Program Analyst (LPA) Maja Jensen arrived at a temporary relocation facility, unannounced, to conduct a health and safety check for residents that have been relocated as a safety precaution. LPA Jensen met with Administrator Maria Linda Estrada and care staff Maria Nelina Estrada and explained the purpose of today's visit.

LPA Jensen conducted this visit at a lodging facility on North Center Street in Stockton. The facility is a three story lodging property with individual rooms that have doors exiting to the parking lot. All residents of Oakhaven are currently lodged on the first floor. There are 7 rented rooms, 6 rooms for residents and 1 for staff. Oakhaven care home is currently undergoing treatment for pest infestation. LPA Jensen requested an update on the pest services that have been contracted for and was advised that if all goes according to plan, the residents should be able to return home on Monday December 18, 2023.

LPA Jensen interviewed care staff Maria Nelina Estrada who advised that staff are currently checking on residents every 30 minutes. LPA Jensen was also advised that residents are being checked on at least 2 times over night. LPA Jensen observed sufficient food and beverages available and stored in the staff room. Medication was observed to be stored in the staff room. LPA Jensen reviewed medical records for Resident 1 (R1). Facility staff advised they were in the process of submitting incident reports for R1's recent hospitalizations. LPA Jensen was advised by care staff that 9 of 10 residents are able to leave a care facility unassisted. 1 of 10 requires assistance to enter the community.

There were 3 staff members in total at the time of this visit. LPA Jensen toured each room and spoke to all residents temporarily relocated. LPA Jensen found 1 of 6 resident rooms to be malodorous. LPA Jensen provided technical assistance in the areas of food service, incontinence care, evictions and reporting requirements.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2023
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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