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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
507206802
Report Date:
11/18/2024
Date Signed:
12/09/2024 01:03:00 PM
Document Has Been Signed on
12/09/2024 01:03 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:
GRACEFUL LIVING AT OAKDALE 2
FACILITY NUMBER:
507206802
ADMINISTRATOR/
DIRECTOR:
MATIS, VOICA
FACILITY TYPE:
740
ADDRESS:
1188 DEITZ CIRCLE
TELEPHONE:
(209) 595-1028
CITY:
OAKDALE
STATE:
CA
ZIP CODE:
95361
CAPACITY:
6
TOTAL ENROLLED CHILDREN:
0
CENSUS:
5
DATE:
11/18/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:
Voica Matis
TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 11/18/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual visit. LPA Jensen met with Licensee Voica Matis and explained the purpose of today's visit. The inspection tool was used during the course of this inspection.
LPA Jensen toured the grounds and observed them to be well maintained. There is patio furniture and shaded areas for client engagement. All paths were free of obstruction. LPA Jensen inspected the interior of the facility and observed it to be sanitary and free of odor. The furniture and lighting were observed to be adequate throughout. The thermostat was set at 74 degrees for the comfort of the residents. The water temperature in the bathroom was measured at 108 degrees Fahrenheit which falls in within the required range of 105-120 degrees Fahrenheit.
The facility maintains a first aid kit that is complete and in compliance. Fire drills are conducted on a regular basis. The carbon monoxide detector was determined to be in good working order. The fire extinguisher was last serviced in February of 2024 and is in compliance. All paths were free of obstruction. Toxins and medications were locked and inaccessible to residents in care.
LPA Jensen inspected the kitchen and observed in excess of 2 days of perishable food and 7 days of non-perishable food. The menu for the month is posted in a visible area and has a variety of offerings from different cultures. LPA Jensen observed fresh fruit and vegetables to be available.
LPA Jensen reviewed 4 resident files and 2 staff files and determined them to be complete and in compliance. LPA Jensen interviewed 2 residents who stated they were satisfied with all aspects of care. LPA Jensen interviewed 2 staff members who were adequately able to answer all questions asked. The facility is in substantial compliance. No deficiencies were observed. An exit interview was conducted and a copy of this report given.
Lisa Rios
TELEPHONE:
(916) 969-9685
Maja Jensen
TELEPHONE:
(916) 639-5584
DATE:
11/18/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/18/2024
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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