Oakley Assisted Living Llc

On 10/09/2025 at 9:53AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Administrator, Nicolette Lake and explained the purpose of the visit. The Administrator currently holds a certificate (#7014095740) expired on 10/04/2025, certificate is being processed and is in pending status per CCLD portal. The facility’s fire clearance was approved for five (5) non ambulatory residents and one (1) bedridden resident. LPA toured facility with Nicolette including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 bedrooms in total and four (4) bathrooms. ADL unit in the backyard is occupied by Administrator. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents shared and private bathrooms were measured at 110.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7-day supply of nonperishable and 2 days of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents . Continue on LIC809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/07/2025. Emergency Disaster Plan was last posted on 10/09/2025. First aid kit was observed to be complete. LPA reviewed all six (6) resident records, four (4) staff records and they were all complete. LPA also reviewed medications and MAR during visit. The following forms are to be updated and submitted to CCLD by 10/16/2025: LIC 500 Personnel Report LIC 400 Affidavit Regarding Client/Resident Cash Resources LIC 402 Surety Bond LIC610E Emergency Disaster Plan LIC308 Designation of facility responsibility No deficiencies observed during visit. Exit interview conducted and a copy of this report provided to Nicolette Lake .

On 10/21/2024 at 11:00AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Administrator, Nicolette Lake and explained the purpose of the visit. The Administrator currently holds a certificate (# 7014095740 ) expires on 10/04/2025. The facility’s fire clearance was approved for five (5) non ambulatory and one (1) bedridden residents. LPA toured facility with Nicolette including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which all 4 bedrooms are occupied by the residents and four (4) bathrooms. Administrators occupy in-law unit in the back yard, residents do not have access to it. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPA observed an additional unit in the backyard where pool was originally (LPA obtained permit during visit). The unit isn't part of the licensed facility, it's a stand alone unit with a separate address. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared and private bathrooms were measured at 116.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/05/2024. Emergency Disaster Plan was last posted on 08/01/2024. First aid kit was observed to be complete. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809. LPA reviewed all six (6) resident records, four (4) staff records one and they all were complete LPA reviewed a sample of medication during visit. The following forms to be updated and submitted to CCLD by 10/28/2024: · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 402 Surety Bond · LIC610E Emergency Disaster Plan · LIC308 Designation of facility responsibility No deficiencies observed during visit. Exit interview conducted and a copy of this report provided to Nicolette Lake.

On 10/24/2023 at 12:20 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Noah Lake and explained the purpose of the visit. The facility’s fire clearance was approved for 5 Non-Ambulatory and 1 Bedridden. LPA toured facility with Noah including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which all 4 bedrooms are occupied by the residents. Administrators occupy in-law unit, residents do not have access to it. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared and private bathrooms were measured within range of 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/06/20203. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 08/23/2023. Report continues on 809 C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 At 12:40 PM, LPA reviewed 5 of 5 residents records. At 1:00 PM, LPA reviewed 5 of 6 staff records and 5 of 5 have first aid training and associated to the facility. At approximately 1:40 PM LPA reviewed a sample of 6 of 6 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/14/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 02/08/2023, Licensing Program Analysts (LPAs) L. Ibo and L. Alexander conducted an unannounced case management visit in regard to the unusual incident report received on 2/3/2023. LPAs met with Administrator, Nicolette Lake and explained the purpose of the visit. Based on unusual report received, on 2/2/2023, R1 was being fed his breakfast and was holding his mouth then he made chocking sound, his face begun to pale, and his lips was bluish he then coughed and started breathing again. Staff called 9-1-1. R1 was brought to nearby hospital. Around 2:15PM R1 was pronounced dead at the hospital. Records review and interview revealed that R1 was not under hospice care. LPAs gathered documents such as but not limited to; LIC602, pre-appraisal needs and care plan. LPAs requested from Administrator a copy of death certificate and copy of Physician orders for life-sustaining treatment (POLST). LPAs do not have available documents currently. LPAs will return to the facility as soon as all information are received. Exit interview conducted with Nicolette Lake. A copy of this report provided.