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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700475
Report Date: 03/29/2022
Date Signed: 03/29/2022 04:18:51 PM


Document Has Been Signed on 03/29/2022 04:18 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:OAKS AT INGLEWOOD ASSISTED LIVING, THEFACILITY NUMBER:
392700475
ADMINISTRATOR:WRIGHT, DIANEFACILITY TYPE:
740
ADDRESS:6725 INGLEWOOD AVETELEPHONE:
(209) 957-6257
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:86CENSUS: 72DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Diane Wright, Executive DirectorTIME COMPLETED:
12:30 PM
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On 03/29/2022 at 9:30 AM, Licensing Program Analyst (LPA)T. White conducted unannounced 1- year required inspection. LPA was allowed entry into the facility that is licensed for a capacity of 86 non-abmbulatory residents, of which 5 residents may be on hospice. LPA completed COVID screening upon entry. LPA met with Executive Director (ED), Diane Wright and explained the purpose of today's inspection. Executive Director holds certificate #60336316740 which expires on 08/07/2023.

LPA toured the facility including but not limited to kitchen, dining room, apartments, bathrooms, storage areas, activity rooms, outdoor areas, and laundry rooms. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. LPA observed activity schedule and facility menu. The hot water temperature in the residents’ apartments was measured at 120 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

Based on ED's interview, smoke detectors and carbon monoxide are interconnected with the fire department. Fire extinguisher was last serviced on March 22,2022. Emergency Disaster Plan was last posted on 03/14/2022. First aid kit was observed to be complete. Fire drill was last conducted on 03/23/2022. LPA observed completed mitigation plan. LPA reviewed 5 resident files and 5 staff records.

No deficiencies cited during inspection.

Exit interview conducted with Executive Director and a copy of report given.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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