<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507203056
Report Date: 10/17/2023
Date Signed: 10/17/2023 02:10:19 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/17/2023 02:10 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 AC/SC, 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:
10/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria Denton, AdministratorTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Renee Campbell arrived at Standing Oak Manor to conduct an Unannounced Required 1 year Annual Inspection on 10/17/2023, at approximately 9:45 am. LPA met with Caregiver Rosita Santos and Licensee/Administrator Maria Denton. The facility census is currently 5.

LPA and facility representative toured the facility to ensure the health and safety of the clients in care. Areas inspected by LPA and representative included but were not limited to the kitchen, client bedrooms, client bathrooms, living and dining room, garage and outdoor areas.

LPA measured the water temperature at 105.8 which meets the regulatory standard. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. LPA observed that, chemicals and toxins were not stored securely and items were accessible to clients. LPA observed fire extinguishers were last inspected on 11/09/2023 and smoke detectors were tested and found to be current and in compliance with Fire Safety standards. LPA notes the facility has the required carbon monoxide detectors. First aid kit was checked and is complete.

LPA verified facility contact information and requested client and staff files for review. LPA reviewed 4 of 5 client files and 1 of 2 staff files. A review of client records indicates that all facility staff & other individuals who require caregiver background checks are fingerprint cleared to the facility.

Per California Code of Regulations, Title 22 there was one deficiency cited during today's inspection.

An exit interview was conducted with administrator. Appeal rights, and a copy of this report was left at the facility.

SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/17/2023 02:10 PM - It Cannot Be Edited


Created By: Renee Campbell On 10/17/2023 at 01:32 PM
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
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: STANDING OAK MANOR
FACILITY NUMBER: 507203056

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2023
Section Cited
CCR
80087(g)(1)

1
2
3
4
5
6
7
Buildings and Grounds: (g) Disinfectants, cleaning solutions, poisons ... and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee locked up the cleaning solutions during this visit. This POC will be cleared.
8
9
10
11
12
13
14
Based on observation of cleaning solutions left in an unlocked and accessible cabinet, the licensee did not ensure cleaning solutions were kept inaccessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Emerita Curiel
LICENSING EVALUATOR NAME:Renee Campbell
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2