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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701057
Report Date: 07/11/2022
Date Signed: 07/14/2022 04:27:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/14/2022 04:27 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: 66DATE:
07/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:P. HolguinTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual inspection on this date. LPA met with Administrator and explained the purpose of the visit.

LPA inspected physical plant including but not limited to kitchen, bathrooms, activity areas and 2 vans used for transportation. LPA observed sufficient furniture and lighting throughout the facility. There is no secured body of water present in or around the facility.

Hot water temperature was measured at 103.5 degrees Fahrenheit in resident bathroom sink, which is not within the required range of 105 to 120 degrees (Advisory given). Fire extinguishers are current and in compliance with fire safety. Carbon dioxide monitor present. LPA reviewed 10 residents and 5 staff files, including criminal record clearances. All staff today are associated to the facility. First aid kit was checked and is complete. Liability insurance is current.

LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. Fire drill was conducted on 7/11/2022.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, No deficiencies were cited during this visit.

Exit interview held and a report given
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2022
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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