390303860-2-1-2024-27-AS-MBIR-D22UUT-20240201145403

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 02/01/2024
Date Signed: 02/01/2024 02:54:44 PM

Document Has Been Signed on 02/01/2024 02:54 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:	OAKHAVEN		FACILITY NUMBER:	390303860
ADMINISTRATOR:	MARIA LINDA ESTRADA		FACILITY TYPE:	740
ADDRESS:	725 EAST OAK STREET		TELEPHONE:	(209) 465-2597
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95202
CAPACITY:	15	CENSUS: 1	DATE:	02/01/2024
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Maria Linda Estrada		TIME COMPLETED:	02:30 PM

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On 2-1-24 at 2:00pm, the Regional Office conducted an informal meeting with facility to discuss recent additional concerns. This meeting was held virtually via Teams Meeting. Present at the meeting were Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Michael Bilger, Licensee Maria Linda Estrada, Assistant Administrator Maria Estrada, and Ombudsman Kathryn Thomas. Topics in this meeting included: (1) Care and Supervision and (2) Facility Closure Procedures.

The licensee stated that the facility has the intention to close. Currently one resident resides at the facility as all other previous residents have since moved out. Licensee began proceedings for closure and submitted a 60-day notice of closure to Licensing department which is approved. LPM and LPA discussed closure procedures with Licensee to ensure a smooth process and transition for the remaining resident which included additional placement assistance, eviction letter contents, and assisted living waiver options. Licensee inquired that if resident was sent to hospital could hospital assist in discharge process. LPA informed Licensee that such action may be interpreted as an illegal eviction and subject to a citation.

Additionally, LPA, LPM and Ombudsman discussed with Licensee personal rights of previous residents in regards to personal items left after their discharges. Licensee was made aware that previous residents have a right to their belongings and should be able to obtain them upon their request. {Cont. on 809C}

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OAKHAVEN	FACILITY NUMBER: 390303860
	VISIT DATE: 02/01/2024

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Licensee stated current facilities are reluctant to take these items out of fear of obtaining bed bugs.

During today’s meeting, Licensee has agreed to the following: (1) Complete closure process as discussed, and (2) On-going checks throughout facility for any signs of bed bugs and head lice, and notify pest control immediately upon any concerns, and (3) Continue to reach out to previous facility and resident’s responsible parties for purpose of obtaining left personal items.

The department is requesting the following:

1. Closure roster upon discharge of remaining resident

2. Inquire with the Department and Ombudsman regarding additional placement options.

The Department shall conduct quarterly visits to ensure compliance with the above and all other Title 22 requirements. Quarterly visits shall consist of, but not be limited to: (1) Review of client files, (2) Review of medication administration records and check list, (3) Inspection of resident rooms and common areas, and (4) Review of staffing files. LPM and LPA notified Administrator that future non-compliance regarding the above and other regulatory components will result in additional citations, civil penalties, and a non-compliance conference to discuss further potential administrative action.

An exit interview was conducted with Maria Linda Estrada and a copy of the report was emailed to Maria with a request for return with signature.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC809 (FAS) - (06/04)

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