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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610233
Report Date: 12/15/2022
Date Signed: 12/15/2022 01:40:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20221207081308
FACILITY NAME:OASIS SENIOR LIVINGFACILITY NUMBER:
197610233
ADMINISTRATOR:KHAMBEKYAN, SANDYFACILITY TYPE:
740
ADDRESS:7001 GARDEN GROVE AVENUETELEPHONE:
(310) 666-2392
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 5DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Khatchik DanielianTIME COMPLETED:
01:52 PM
ALLEGATION(S):
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Staff are not following COVID-19 guidelines.
INVESTIGATION FINDINGS:
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At 12:16 p.m. on 12/15/2022 Licensing Program Analyst (LPA) Nicholas Reed an unannounced complaint visit. LPA met with Staff #1 (S1) and later Administrator and disclosed the reason for the visit. LPA and S1 toured the facility inside and out. No immediate health or safety concerns were observed.

Regarding the allegation above, it was alleged staff were not wearing masks in the facility. From observations of a credible witness, staff were observed without masks in the facility during an unannounced visit on 11/16/2022. From observations of LPA today, 1 out of 2 staff were observed wearing a mask. Staff #2 (S2) was observed working without a mask. S2 independently put on a mask after LPA arrived. Based on observations, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on LIC 9099-D.

Exit interview conducted. Appeal Rights discussed. Copy of report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20221207081308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 197610233
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2023
Section Cited
CCR
87470(c)(1)(F)
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87470 Infection Control Requirements
(c) An Infection Control Plan shall be developed...(1) The Infection Control Plan shall include all of the following: (F) Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned...
This requirement was not met as evidenced by:
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Licensee will provide training on the cited section to all staff and submit proof by the POC due date.
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Based on observations and interviews, the licensee did not comply with the section cited above in 1 out of 2 staff which posed a potential Health, Safety, or Personal Rights risk to persons in care.
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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: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2