<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 12/14/2023
Date Signed: 12/14/2023 03:54:23 PM


Document Has Been Signed on 12/14/2023 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: 9DATE:
12/14/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maria Nelina Estrada, staff on dutyTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/13/23 at 3pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct a health and safety visit at a lodging located at 33 N Center St, Stockton, CA 95202. LPA met with facility staff Maria Nelina Estrada and explained the purpose of the visit. Residents in care have been temporarily relocated to this lodging due to facility location undergoing pest control services. During this visit, there are currently 9 residents in care residing at this lodging location with 3 staff on duty. LPA conducted an interview with the staff for the updates on the facility's current situation. Per staff, pest control company began the fumigating process of the facility today. LPA and staff also visited and observed each resident's rooms. Five rooms are occupied by residents with 2 room occupied by staff. There are 2 residents to each room with the exception of 1 resident who occupy own room. LPA observed rooms to be clean and sanitary with no foul odors, and contain full size refrigerators, televisions, full size beds, night stands, and adequate storage space. Residents' have appropriate amounts of clothing and other personal items in rooms. Laundry continues to be provided by facility staff using the lodging laundry services. Interview of residents in care informed LPA that residents are doing well.

LPA observed residents' medications are kept locked in the staff room and inaccessible to residents in care. It was also observed that there is an adequate amount of food and are being stored in one of the staff room. Additionally, food is ordered outside by facility staff for residents. LPA observed all resident files on site. Per interview and document review, staff are checking on residents every 30 minutes. Per interview with the staff, staff continue to follow the developed menu for residents which includes breakfast, lunch, dinner and 3 snack times. Food options include fruit, cereal, pastries, bread, sandwich meat, cheese, and fish. Beverages include milk, water, and juice products. Food ordered from outside is also included on the menu.

Licensing department will continue to conduct health and safety checks at this time. Tentative date to return to facility is 12/18/23 pending clearance by pest control. No citations issued today. An exit interview was conducted with Maria Nelina Estrada and a copy of this report was provided to Maria.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin VillanuevaTELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1