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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392701057
Report Date:
05/10/2024
Date Signed:
05/13/2024 03:52:08 PM
Document Has Been Signed on
05/13/2024 03:52 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:
OAKMONT OF BROOKSIDE
FACILITY NUMBER:
392701057
ADMINISTRATOR:
TRACY BURKE
FACILITY TYPE:
740
ADDRESS:
3318 BROOKSIDE ROAD
TELEPHONE:
(209) 473-1300
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95219
CAPACITY:
81
CENSUS:
80
DATE:
05/10/2024
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
R.Jewel-Richardson
TIME COMPLETED:
02:00 PM
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Report was amended to change the plan of correction date from 5/11/2024 to 5/15/24. The updated report is dated 5/13/2024.
SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Albert Johnson
TELEPHONE:
(916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE:
05/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/13/2024
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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