Community Care Licensing

Document Has Been Signed on 09/13/2023 02:29 PM - It Cannot Be Edited

FACILITY NAME:	OAKMONT OF BROOKSIDE		FACILITY NUMBER:	392701057
ADMINISTRATOR:	HOLGUIN, PATRICIA		FACILITY TYPE:	740
ADDRESS:	3318 BROOKSIDE ROAD		TELEPHONE:	(209) 473-1300
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY: 81		CENSUS: 70	DATE:	09/13/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	P. Holguin		TIME COMPLETED:	02:15 PM

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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the complaint investigation conducted on 8/28/2023 . Deficiency cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC. Section Cited: 87465(c)(2) Date Due: 08/29/2023 Plan of Correction: The Administrator will developed a plan on how the facility will follow the Physician's orders and document correctly when medications are missed. Please send the agenda along with the sign-in sheet for the in-service, by POC date or give a time when the training will take place and send that information to the department Corrections: Cleared By Visit Clearance Date: 09/13/2023 Exit interview conducted.

SUPERVISORS NAME: Stephenie Doub LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023