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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392700475
Report Date:
10/10/2024
Date Signed:
10/11/2024 08:32:15 AM
Document Has Been Signed on
10/11/2024 08:32 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:
OAKS AT INGLEWOOD ASSISTED LIVING, THE
FACILITY NUMBER:
392700475
ADMINISTRATOR:
BRITTANY ANDREWS
FACILITY TYPE:
740
ADDRESS:
6725 INGLEWOOD AVE
TELEPHONE:
(209) 957-6257
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95207
CAPACITY:
86
CENSUS:
70
DATE:
10/10/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
01:14 PM
MET WITH:
Tha Chay
TIME COMPLETED:
03:04 PM
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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the licensing visit conducted on 9/24/2024.
Deficiency cited under Title 22 Regulations have been cleared.
Administrator/Licensee complied with the terms of the POC by POC due date.
Facility was provided POC cleared letter.
SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Albert Johnson
TELEPHONE:
(916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE:
10/10/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/10/2024
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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