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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002810
Report Date: 11/22/2024
Date Signed: 11/22/2024 04:23:04 PM

Document Has Been Signed on 11/22/2024 04:23 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:OAKS FAMILY CAREFACILITY NUMBER:
347002810
ADMINISTRATOR/
DIRECTOR:		MIN, OKGIFACILITY TYPE:
740
ADDRESS:9456 BLUE DIAMOND WAYTELEPHONE:
(916) 714-1796
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 4DATE:
11/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:03 PM
MET WITH:Okgi MinTIME VISIT/
INSPECTION COMPLETED:
04:22 PM
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On 11/22/24, at 4:03 pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct a case management visit for the purpose of delivering an Order to Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion from Facility. LPA met with Okgi Min, Administrator, and explained the purpose of the visit.

Staff (S1) is excluded as a result not related to this facility. Per Administrator, S1 resigned on 11/15/24.

LPA served notice of "ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY" for S1 who was not present at the time of visit. Administrator was advised an immediate removal is warranted and requested the Personnel Report (LIC500) and Guardian account be updated to remove S1 from the facility staff roster. A notice of completion shall be submitted to Community Care Licensing (CCL).



LPA informed the Administrator that S1 is not allowed to be employed and/or on any facility premises. The Order to Individual of Immediate Exclusion From All Facilities will be in effect as of 11/22/24 upon receipt of the letter. A copy of the letter was given to the facility during this visit.

The facility understands this is an Immediate Exclusion and has agreed S1 cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services unless otherwise ordered by the Department.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed and cited.
Exit interview held with Oki Min, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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