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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701057
Report Date: 07/26/2023
Date Signed: 08/03/2023 12:36:58 PM


Document Has Been Signed on 08/03/2023 12:36 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:OAKMONT OF BROOKSIDEFACILITY NUMBER:
392701057
ADMINISTRATOR:HOLGUIN, PATRICIAFACILITY TYPE:
740
ADDRESS:3318 BROOKSIDE ROADTELEPHONE:
(209) 473-1300
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:81CENSUS: 49DATE:
07/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:P. HolguinTIME COMPLETED:
02:28 PM
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The following deficiencies, initially cited during a visit on 07/17/2023, have been cleared:

Section Cited: 87555(b)(9)Date Due: 07/24/2023
Plan of Correction:
Facility agrees to a deep cleaning of kitchen and food storage area. The facility manager indicated that a kitchen staff membesr recently ended their employment and new kitchen staff are on board.		Corrections:
faxes		Clearance Date:
07/26/2023
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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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