<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701053
Report Date: 02/04/2022
Date Signed: 02/04/2022 04:53:37 PM

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:OXFORD MANORFACILITY NUMBER:
392701053
ADMINISTRATOR:HILL, SIMILYFACILITY TYPE:
740
ADDRESS:2313 OXFORD CIRCLETELEPHONE:
(415) 756-3652
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:6CENSUS: 2DATE:
02/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator Simily HillTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/4/22, Licensing Program Analyst (LPA) Jason Lund arrived at this facility unannounced to conduct a case management visit. LPA was greeted by Administrator Simily Hill and Licensee Penya Hill by phone. LPA explained the purpose of the visit.

On 2/2/22 it was reported that the facility pet dog (Sammy) had an altercation with another dog (Not facility dog) from the area on the grounds of the facility (Front yard). Sammy got of the facility through the side front door window. Sammy is know quarantined for the next 10 days per City of Stockton Animal Services. LPA Lund met with Sammy and she is very calm dog. LPA Lund, Administrator Simily Hill and Licensee Penya Hill spoke about how to try to have Sammy not to get out the facility again. The facility will not open the front windows any longer and have Sammy on a leash (With dog muzzle) when she is being walked outside the facility.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Administrator Simily Hill and Licensee Penya Hill by phone and a report was given to Administrator Simily Hill.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1