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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507203056
Report Date: 12/19/2022
Date Signed: 12/20/2022 09:48:52 AM

Document Has Been Signed on 12/20/2022 09:48 AM - 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:STANDING OAK MANORFACILITY NUMBER:
507203056
ADMINISTRATOR:MARIA DENTONFACILITY TYPE:
735
ADDRESS:3770 STANDING OAK DRIVETELEPHONE:
(209) 541-1069
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 6CENSUS: 5DATE:
12/19/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Rosita SantosTIME COMPLETED:
02:30 PM
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Unannounced Plan of Correction visit made out to this facility on 12/19/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility live-in caregiver, Rosita Santos, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Maria Denton, to inform her that CCL was present at this time.
It was learned that the facility designated Administrator was unable to make it to today's Plan of Correction visit and allowed for the facility live-in caregiver, Rosita Santos, to go ahead and sign all of the documents related to CCL's visit at this time.
The purpose of this visit was to follow up on the plan of correction that was required from prior annual visit conducted on 11/17/2022 with the following deficiencies:
  • Based on observation, the licensee did not comply with the section cited above in that several window screens were missing from resident bedrooms which poses/posed a potential health, safety or personal rights risk to persons in care.

  • Based on observation, the licensee did not comply with the section cited above in [1] out of [3] toilets reviewed showed that it was leaking water and was in need of repair which poses/posed a potential health, safety or personal rights risk to persons in care.


There were no deficiencies observed or cited during today's plan of correction visit.

Plan of correction clearance letter was printed and a copy was given to the facility live-in caregiver at this time.

Exit Interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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