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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608846
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:46:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:OASIS SENIOR LIVINGFACILITY NUMBER:
197608846
ADMINISTRATOR:GRANT ABADZHYANFACILITY TYPE:
740
ADDRESS:7001 GARDEN GROVETELEPHONE:
(818) 697-5253
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: DATE:
11/18/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Dinah PascoTIME COMPLETED:
11:50 AM
NARRATIVE
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On 11/18/2021 at 10:15 AM, Licensing Program Analyst (LPA) Nicholas Reed met with Administrator for an unannounced Case Management visit due to recent deficiencies.

LPA expressed concern over a Death Report.

On 11/03/2021, the Centralized Complaint and Information Bureau (CCIB) received a Death Report from Sweet Touch Hospice Inc. The Death Report was dated 10/15/2021 and was postmarked on 10/21/2021. The report was sent to CDSS headquarters in Sacramento. On 11/03/2021, LPA called Administrator to inform of proper death reporting procedures. Administrator stated she will follow protocol next time.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OASIS SENIOR LIVING
FACILITY NUMBER: 197608846
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2021
Section Cited

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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency ... (1) A written report ... within seven days of the occurrence of ... (A) Death of any resident from any cause regardless of where the death occurred.
This requirement is not met as evidenced by:
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Based on LPA records review and interview, it is determined Licensee failed to report the death of a resident to Community Care Licensing. This posed a potential health and safety risk to residents in care. Deficiency issued, exit interview conducted, report emailed and Plan of Correction created.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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