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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 09/04/2024
Date Signed: 09/04/2024 01:19:57 PM


Document Has Been Signed on 09/04/2024 01:19 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: 1DATE:
09/04/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Maria Linda EstradaTIME COMPLETED:
01:40 PM
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On 9-4-24 at 12:25pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a quarterly health and safety check. LPA met with Licensee Maria Linda Estrada and facility manager and explained the purpose of the visit. LPA observed facility premises including living room area, dining room area, hallways, kitchen area, resident bedrooms, bathrooms, and outside area of facility. Facility's current census is 1. LPA observed facility to be clean and sanitary throughout with no foul odors,

LPA did not observe evidence of bed bugs or head lice. Facility maintains on-going pest control services. Medication log sheets were reviewed for accuracy. Records reviewed revealed staff assist resident with medications as prescribed. Staff files were also reviewed for completeness. Facility is continuing with the closure process pending the appropriate discharge of remaining resident in care.

As a result of today's inspection, no citations are issued. The Department will continue to perform quarterly health and safety visits as noted in the original report dated 2-1-2024. An exit interview was conducted with Maria Linda Estrada and assistant administrator, and a copy of this report was provided to Maria. Assistant administrator signed with permission by Maria Linda Estrada.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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