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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507203056
Report Date: 11/08/2024
Date Signed: 11/12/2024 02:37:26 PM

Document Has Been Signed on 11/12/2024 02:37 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:STANDING OAK MANORFACILITY NUMBER:
507203056
ADMINISTRATOR/
DIRECTOR:		MARIA DENTONFACILITY TYPE:
735
ADDRESS:3770 STANDING OAK DRIVETELEPHONE:
(209) 541-1069
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 6CENSUS: 5DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Maria Denton, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 11/08/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced to conduct an annual inspection. LPA Campbell met with Ricarte Langcao, Direct Service Provider and explained the purpose of the visit. Administrator Maria Denton arrived 15 minutes later.

During the course of the inspection, LPA Campbell conducted a tour of the facility. The facility is a single floor building with four bedrooms and three bathrooms. The layout matches the facility sketch and no changes have been made. It is licensed for six ambulatory mentally disabled adults between the ages of 18-59 years of age. Two of the bedrooms are shared with two residents in each bedroom. One bedroom has only one resident. One staff person lives on the premises in the master bedroom. The backyard was clear of debris and contained a seating area with shade and a fruit tree in the corner. The fire exit was unobstructed and lead directly to the street in front of the house.

In the kitchen, LPA Campbell observed a locked sharps drawer and enough perishable food for 3 days and enough non-perishable food for 7 days. The freezer temperature was measured at 0 degrees Fahrenheit (F) and the refrigerator temperature was 38 degrees F. Clean dishes and utensils were observed stacked on shelves and in drawers.


SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: STANDING OAK MANOR
FACILITY NUMBER: 507203056
VISIT DATE: 11/08/2024
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The facility temperature was 71 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature in the bathroom was measured at 119 degrees Fahrenheit and 115 degrees F in the kitchen, which is within the required range of 105 and 120 degrees. The fire extinguisher was fully charged and had been most recently inspected on 12/13/2023.

LPA Campbell reviewed 5 of 5 client files and 2 of 2 staff files. All files were found to be complete.

LPA Campbell observed a table saw in the locked garage for tile cutting to update the bathroom floor over the next two days. The administrator agreed to a plan to ensure the table saw is not unattended and accessible to residents. Today, the administrator and staff agreed to keep the garage door locked and closed. The contractor will also come today and take the table saw from the facility until they return tomorrow. During any period of construction, the administrator and/or staff will remain with the table saw whenever the contractor has to leave the table saw unattended. Until the job is done, the contractor will take the table saw with him when he is done for the day.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. An exit interview was conducted with Maria Denton and a copy of this report was provided.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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