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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390303860
Report Date: 12/06/2023
Date Signed: 12/06/2023 11:57:30 AM


Document Has Been Signed on 12/06/2023 11:57 AM - 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:
12/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Maria Linda EstradaTIME COMPLETED:
12:00 PM
NARRATIVE
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On 12-6-23 at 11:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding timely medical attention. LPA met with Administrator Maria Linda Estrada and explained the purpose of the visit. During today's visit, it was discovered that at least one resident in care has an occurrence of head and body lice. LPA also conducted brief interview with Administrator. It was revealed through interviews that the identified resident and additional residents in care have not been treated clinically for lice since facility's knowledge of lice on 11-29-23. Additionally, facility has not yet demonstrated a plan for medical attention regarding lice since 11-29-23.

As a result of today's case management, citation is issued under Title 22, Division 6. An exit interview was conducted with Maria Linda Estrada and a copy of this report was provided to Maria. Appeal rights provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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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Document Has Been Signed on 12/06/2023 11:57 AM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2023
Section Cited
CCR
87465(a)(1)

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Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility...(1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by:
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Licensee will arrange for residents in care to be treated accordingly for lice prevention which shall include but not be limited to: Medical appointments and appropriate treatment as prescribed by a licensed professional. Proof of medical intervention to be submitted to LPA by POC due date.
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Based on interview, facility had knowledge of head and body lice occurence within the faciity on 11-29-23 and have not made arrangements to treat clinically at this time. This poses a potential healh and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
LIC809 (FAS) - (06/04)
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