197610023-12-10-2024-31-AS-JGTN-DBTT88-20241210132954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610023
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:30:05 PM

Document Has Been Signed on 12/10/2024 01:30 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	A TIMIA OASIS		FACILITY NUMBER:	197610023
ADMINISTRATOR/ DIRECTOR:	JHA, AKHILESH KUMAR		FACILITY TYPE:	740
ADDRESS:	15116 ROXFORD STREET		TELEPHONE:	(310) 995-4859
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	12/10/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:15 PM
MET WITH:	Flordeliz Chico - Staff		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced case management visit at this facility in conjunction with a complaint investigation control no.: 31-AS-20241127155153. LPA met with staff Flordeliz Chico who called the Designee Patria Dufrenne and the reason for the visit was explained. Ms. Dufrenne designated Ms. Chico to sign the report.

On 12/05/24 at around 9:30 AM. LPA & Licensing Program Manager (LPM) Troy Agard conducted a physical plant tour of the four (4) facilities on the property from 9:30 AM to 10:15 AM. The following health and safety violations were observed at this facility:

1) The door leading to the common area was propped open by the sofa at the living area.

Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.

Troy Agard	TELEPHONE: (818) 596-4342
Jose Gary Tan	TELEPHONE: (323) 213-1149
	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

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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Document Has Been Signed on 12/10/2024 01:30 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A TIMIA OASIS	FACILITY NUMBER: 197610023
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Personal Accommodations and Services: The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction.
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 12/10/2024
	Plan of Correction
1 2 3 4	The staff freed the door from the furniture and during this visit, the door has no obstruction. Cleared during visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Troy Agard	TELEPHONE: (818) 596-4342
Jose Gary Tan	TELEPHONE: (323) 213-1149
	DATE: 12/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024

LIC809 (FAS) - (06/04)

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