197610023-4-28-2024-31-AS-JGTN-D4RPXJ-20240428114225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610023
Report Date: 04/28/2024
Date Signed: 04/28/2024 11:42:52 AM

Document Has Been Signed on 04/28/2024 11:42 AM - 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:	OASIS MANORS INC.		FACILITY NUMBER:	197610023
ADMINISTRATOR:	JHA, AKHILESH KUMAR		FACILITY TYPE:	740
ADDRESS:	15116 ROXFORD STREET		TELEPHONE:	(310) 995-4859
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	6	CENSUS: 0	DATE:	04/28/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Akilesh Jha - Administrator		TIME COMPLETED:	11:45 AM

NARRATIVE
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	Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with administrator Akilesh Jha and explained the purpose of this visit. The facility is currently no clients at this time. A tour of the physical plant was conducted at 9:02 AM and the following was observed: The facility has one main entrance being used, the main door has required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) are posted on the door. The PPE screening station is located immediately upon entrance and had a table equipped with sufficient PPE readily accessible, a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. The facility has an approved mitigation plan on file. The facility is a single storey duplex type building with three other Residential Care Facility for the Elderly (RCFE) facilities inside the compound . It has five (5) bedrooms and three (3) bathrooms. One (1) bedroom is a shared room and the rest are private. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which maybe bedridden on Room #1. Hospice waiver for six (6) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 73°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected and observed to be operational. There is a Fire extinguisher is located in the kitchen and observed to be last bought on 11/02/23. The facility is equipped with sprinkler system. (continued on LIC 809-C)

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2024

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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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: OASIS MANORS INC.	FACILITY NUMBER: 197610023
	VISIT DATE: 04/28/2024

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(continued from LIC 809)

Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry area is located in the staff office on a separate building beside the facility. Laundry detergent, cleaning solutions and other toxins are observed to be locked in the staff office.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee.

The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at a range of 112.1°F to 117.2°F Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet.

Medications: LPA observed that the medication will be kept in the cabinet in the living room area and was observed to be locked and inaccessible. There was a complete first aid kit located inside the medication cabinet.

Garage: There is no garage at the facility only car ports at the front area. The Backyard had a covered shaded area for clients with outdoor furniture. The swimming pool is appropriately fenced and was observed to be locked during visit.

Client records. There is no resident at the facility at this time.

Exit interview conducted. Copy of this report issued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2024

LIC809 (FAS) - (06/04)

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