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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507203056
Report Date: 09/25/2025
Date Signed: 09/25/2025 12:37:57 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/25/2025 12:37 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: 6DATE:
09/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH: Maria Denton, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 09/25/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the community unannounced regarding the annual inspection. LPA Campbell met with Maria Denton, Licensee and explained the purpose of the visit. The community is licensed to serve mentally disabled adults between the ages of 18-59 years of age. It is housed in a one story building with four bedrooms and 3 bathrooms.

Upon arrival, LPA Campbell was greeted by a resident who opened the door. Staff was observed further inside in the living room. When LPA Campbell sat the dining room table, the medicine cabinet was observed with a drawer partially open with the key hanging from the lock while staff was in the kitchen. Staff later assisted a client with their medicine and then went back into the kitchen with the key still hanging in the lock.

LPA Campbell proceeded to inspect the common areas, kitchen, bathrooms, bedrooms and outdoor areas. Upon review, residents have two twin beds in their rooms along with chests, a ceiling light, enough drawers for each resident and a closet space that can be shared. LPA Campbell observed the licensee folding cleaned linens for residents and storing in the closet. In the kitchen, there were enough perishable foods to last two days. There were enough non-perishable foods to last 7 days as well. A locked sharps drawer was observed in the kitchen. The first aid kit was stored in a kitchen cabinet and contained scissors, thermometer, tweezers and the first aid kit manual. The freezer temperature was 0 degrees Fahrenheit (F) and the refrigerator temperature was 42 degrees F. The fire extinguisher was last inspected on January 6, 2025. Outside, there was seating and shade available for residents and fire exits were clear of obstacles.
NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Renee Campbell
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/25/2025 12:37 PM - It Cannot Be Edited


Created By: Renee Campbell On 09/25/2025 at 10:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: STANDING OAK MANOR
FACILITY NUMBER: 507203056

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2025
Section Cited
CCR
80075(k)(1)

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Health Related Services: (k)(1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
This requirement is not met as evidenced
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During the visit, LPA observed the licensee close & lock the medication cabinet & remove key from the lock. Staff will repeat "Assistance with Medication Training" and Licenss will email the certificate to renee.campbell@dss.ca.gov by POC due date.
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Based on observation, the licensee did not ensure staff kept medication in a safe and locked place when a key was left in the medication cabinet lock.

This poses a immediate Health, Safety or personal rights risk to residents in care
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Type B
10/03/2025
Section Cited
CCR80066(a)(6)

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(a) The licensee shall ensure that ... Each personnel record shall contain ... (6) Documentation of the educational background, training and/or experience ..., including types of employment and former employers. This requirement is not met as evidenced by:
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The licensee will obtain staff job applications for all existing staff showing employee education and experience background by the POC due date and review and submit a memo of understanding for LIC80066(a)(6) to LPA Campbell at renee.campbell@dss.ca.gov
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Personnal records were reviewed and found to have no job application or personnal records documenting staff education or experiental background.
This poses a potential Health, Safety or personal rights risk to residents in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Renee Campbell
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2025


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: 09/25/2025
NARRATIVE
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 No odor was observed and pathways were clear and unobstructed. When measured, the water in two bathrooms was found to be 106 degrees in one bathroom and 116 degrees in the other. Window screens were inspected and found to be intact. Five light bulbs were out and had not been replaced. A film of dust was observed on the decor and a significant piece of gum was observed found on the dining room table under box of facial tissues. The bathroom mirror appeared to have not been cleaned for several days.

During the file review, LPA Campbell reviewed all staff files for all 3 staff. None of the staff files had Personnel Records or Job Applications. Of the 6 residents, all 6 of their files were reviewed and found to be complete.

Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited and noted on LIC 809D. Note that failure to correct any deficiencies will result in additional civil  penalties.
NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Renee Campbell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC809 (FAS) - (06/04)
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