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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701053
Report Date: 08/02/2024
Date Signed: 08/02/2024 12:11:56 PM


Document Has Been Signed on 08/02/2024 12:11 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:OXFORD MANORFACILITY NUMBER:
392701053
ADMINISTRATOR:HILL, PENYAFACILITY TYPE:
740
ADDRESS:2313 OXFORD CIRCLETELEPHONE:
(415) 756-3652
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:6CENSUS: DATE:
08/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:P.HillTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual visit on this date. LPA met with Administrator and explained the purpose of the visit.

The facility is a single story structure with wheelchair accessibility. LPA observed all required signage, including COVID related, to be prominently posted. LPA toured the facility indoors and outdoors including but not limited to dining room, living room, kitchen, garage, 2 bathrooms, 3 bedrooms and backyard. The facility is licensed for 6 clients of which all can be non-ambulatory.

Hot water temperature was measured at 115 degrees Fahrenheit in male resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers are current and in compliance with fire safety. Fire drill was conducted on 2/1/2024. Carbon dioxide monitor present. LPA reviewed 1 resident and 1 staff files, including criminal record clearances. All staff today are associated to the facility. First aid kit was checked and is complete.

No deficiencies were cited as a result of today's visit. Advisories given

An exit interview was conducted and left with the facility.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2024
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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