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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236804089
Report Date: 08/12/2024
Date Signed: 08/12/2024 09:14:25 AM

Document Has Been Signed on 08/12/2024 09:14 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/
DIRECTOR:		OKORO, SYLVESTERFACILITY TYPE:
740
ADDRESS:535 E. CHESTNUT STREETTELEPHONE:
(707) 409-5004
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: 6CENSUS: 4DATE:
08/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Valesia ColeTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit in regards to a Fire Clearance request submitted by the facility. LPA met with Administrator Valesia Cole and reviewed documents. LPA discussed fire clearance regulation and Hospice Care regulations. LPA provided copies of Hospice Care regulation.

No deficiencies were observed during this visit. No citations issued.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2024
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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