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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804088
Report Date: 11/03/2022
Date Signed: 11/03/2022 12:07:52 PM

Document Has Been Signed on 11/03/2022 12:07 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:OCEANSIDE CARE HOME LLCFACILITY NUMBER:
236804088
ADMINISTRATOR:OKORO, SYLVESTERFACILITY TYPE:
740
ADDRESS:550 S. FRANKLIN STREETTELEPHONE:
(614) 747-3443
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 5CENSUS: 3DATE:
11/03/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sylvester OkoroTIME COMPLETED:
12:15 PM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold met with Applicant Sylvester Okoro, to conduct an unannounced pre-licensing inspection. LPA toured the facility bedrooms, common rooms and grounds. Facility has a total of four bedrooms for residents. All doorways and walkways are unobstructed and facility is clean and in good repair. Hot water measured within acceptable range between 105 and 120 degrees F. There are books and games and space for resident activities. Facility has a drawer in the kitchen to lock knives and other items dangerous to residents with a dementia diagnosis. There are also locked closets containing toxins and cleaning supplies. LPA observed a good supply of back up linens and toiletries, and the kitchen is stocked with an ample supply of fresh and non-perishable foods.
LPA observed fully charged fire extinguishers, operable smoke alarms and carbon monoxide detectors throughout the facility. All appliances were in place and working. All required postings were posted in a hallway near the entrance to the facility.
Medications are centrally stored and secured. A random sample of facility records were reviewed and LPA observed the appropriate documentation required on file.
Applicant could not provide evidence of Liability insurance at the time of this visit. Applicant will provide evidence of liability insurance to the application unit LPA. Upon receipt of evidence of Liability Insurance, LPA will submit the application packet for a final review and approval from the Licensing Program Manager.
LPA conducted a Component III interview with applicant, and the applicant has shown that they have a good understanding of Title 22, and have appropriate knowledge to operate a residential facility.
License will be granted after application has a final management review.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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