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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804089
Report Date: 05/30/2023
Date Signed: 05/30/2023 09:52:37 AM

Document Has Been Signed on 05/30/2023 09:52 AM - 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:
236804089
ADMINISTRATOR:OKORO, SYLVESTERFACILITY TYPE:
740
ADDRESS:535 E. CHESTNUT STREETTELEPHONE:
(707) 409-5004
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 6CENSUS: 6DATE:
05/30/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Valesia ColeTIME COMPLETED:
10:00 AM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced Post Licensing inspection of this senior care home and met with Care giver Valesia Cole. At approximately 8:45AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerator and freezer were clean, and food was stored properly. Toxins are stored in a locked closet in the hallway. Fire extinguishers inspected were charged. Smoke detectors were in working order. Carbon Monoxide detector was present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secured.

At approximately 9:00AM, LPA reviewed 6 of 6 resident records and found residents to have physician's reports, signed admission agreements, care plans and physician's orders on file. Medication records are thorough and contained physician's orders for each resident. At approximately 9:30AM, LPA reviewed 2 of 2 on duty staff records which contained documentation of current first aid, CPR training, and completed training records as required including course details and hours of completion.

No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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