197608846-3-15-2022-31-AS-NRED-CCJSAV-20220315134258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608846
Report Date: 03/15/2022
Date Signed: 03/15/2022 01:43:46 PM

Document Has Been Signed on 03/15/2022 01:43 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	OASIS SENIOR LIVING		FACILITY NUMBER:	197608846
ADMINISTRATOR:	GRANT ABADZHYAN		FACILITY TYPE:	740
ADDRESS:	7001 GARDEN GROVE		TELEPHONE:	(818) 697-5253
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 6	DATE:	03/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Dinah Pasco		TIME COMPLETED:	01:53 PM

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At approximately 12:00 PM on 03/15/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

Census: 6

The facility is a single story building with 4 bedrooms, 2 bathrooms, a kitchen, living room, and back yard. Bedroom #3 and Bedroom #4 have exit doors which lead to a ramp with sturdy handrails. The facility’s western perimeter is shared with a neighbor.

Upon entry, LPA observed staff and visitors not wearing masks. LPA screened self for temperature and recorded information in a visitor log. LPA suggested a column for symptoms in the visitor log. At the screening station, LPA observed surgical masks, N95 masks, gloves, sanitizer, wipes, gowns, emergency lights, and a first aid kit. LPA observed postings for confidential complaints, the latest Provider Information Notice, administrator certificate, and Ombudsman contact.

Safety: All emergency exit paths were free from obstruction, and all exit gates were unlocked. Emergency exit plans were posted throughout the facility with reference points and routes clearly labeled. LPA tested carbon monoxide and smoke detectors to be functioning. In the kitchen hung 2 fully charged fire extinguishers which were last inspected earlier today, 03/15/2022. LPA heard verbal alerts from an auditory device when exit doors were opened.

Bedrooms: The facility had 4 bedrooms. Bedroom #1 was a shared room and contained a mirror with a large crack in it. The crack did not pose a health and safety risk to residents in care. Bedroom #2 was a private room and contained a bed with half rails. LPA observed a resident lying down with staff supervision. Bedroom #3 was also a private room. Bedroom #4 was a shared room with two bedridden residents with full bedrails. All bedrooms contained a nightstand, lamp, dresser, storage space, chair, and a bed with adequate bedding.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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
	VISIT DATE: 03/15/2022

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Bathrooms: The facility had 2 bathrooms. Both bathrooms were fully stocked with liquid soap, paper towels, handwashing instruction signs, trash cans with tight fitting lids, grab bars around toilets and showers, and non-skid mats.

Kitchen: All sharp objects were locked in the kitchen. Medications were locked in a separate cabinet. LPA observed adequate supplies of perishable and non-perishable food and a weekly menu on the side of the refrigerator. LPA also observed a free house telephone.

Living Room: LPA observed 3 residents sitting in the living room and watching television. Seating was arranged diagonally to accommodate physical distancing.

All furniture, window screens, blinds, ceilings, floors, and walls were clean and in good repair.

Outdoor area: LPA observed a covered and shaded back patio with chairs and a table. All tools and poisons were locked in 3 sheds along the north side of the facility.

During today's visit, facility was not in compliance with Title 22 Regulations and a citation was issued.

Exit interview conducted, citation issued, appeal rights discussed, and copy of the report issued.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/15/2022 01:43 PM - It Cannot Be Edited

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: 03/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/15/2022 Section Cited	1 2 3 4 5 6 7	87470(c) An Infection Control Plan shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and as evidenced by safe and effective job performance.This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on observations, staff and visitors were seen not wearing masks in the facility. The Licensee did not ensure staff performed their job safely. This posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

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