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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610023
Report Date: 03/01/2022
Date Signed: 03/01/2022 12:18:44 PM


Document Has Been Signed on 03/01/2022 12:18 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 MANORS INC.FACILITY NUMBER:
197610023
ADMINISTRATOR:JHA, AKHILESH KUMARFACILITY TYPE:
740
ADDRESS:15116 ROXFORD STREETTELEPHONE:
(310) 995-4859
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 0DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kumar JhaTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness attempted to conduct an annual inspection at the address mentioned above. LPA entered the property gates and observed the facility under remodeling and construction. LPA spoke to Administrator Kumar Jha who informed LPA there are no residents and will start operation once the property construction is completed. LPA will communicate with Administrator regarding possible changes from the facility sketch that was submitted with the original application. If there are changes, a new LIC200 and facility sketch has to be submitted. Administrator not available to sign the report and will be emailed.


Copy of report will be emailed to Administrator.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
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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