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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:10:20 PM


Document Has Been Signed on 12/12/2023 03:10 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:
12/12/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Maria Linda EstradaTIME COMPLETED:
03:30 PM
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On 12-12-23 at 1:20pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a health and safety visit at 33 N Center St, Stockton. LPA met with facility administrator Maria Linda Estrada and explained the purpose of the visit. There are currently 10 residents residing at this motel location due to facility location undergoing pest control services. LPA conducted brief interview with Administrator and observed a total of four staff on duty. Six rooms are occupied by residents with 1 room occupied by staff. There are 2 residents to each room with the exception of one resident who occupies a private 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. Laundry is completed by facility staff on duty using the motel's laundry services.

LPA observed adequate food storage and amounts, and medications were locked and inaccessible to residents in care. Additionally, food is ordered outside by facility staff for residents. LPA observed all resident files on site. LPA also observed staff checking on residents every 30 minutes. Staff maintains a log to record resident checks. Staff has developed a temporary 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. Residents' have appropriate amounts of clothing and other personal items in rooms.

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 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: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023
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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