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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005614
Report Date: 06/24/2021
Date Signed: 06/24/2021 02:45:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:OASIS, THEFACILITY NUMBER:
306005614
ADMINISTRATOR:PEREZ, JENNIFERFACILITY TYPE:
740
ADDRESS:24741 PENFIELD STTELEPHONE:
(949) 454-1503
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 6DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Martin RoblesTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection visit. LPA arrived at facility and was greeted at the door by caregiver and granted entry. LPA met with caregiver and explained the nature of the visit. Caregiver informed Administrator via telephone and spoke with LPA in regard to the visit.

LPA began the tour of the facility accompanied by caregiver. The facility currently has 6 residents in care. LPA observed 3 residents in living room watching TV upon entry. All residents appeared happy and well taken care of. Facility appears clean and sanitary. Facility has one main entry way which all visitors are screen upon entry. Facility keeps documentation for visitors, residents and staff. At 1:40pm LPA tested the hot water temperature in bathrooms which are used by the residents. The hot water temperature was measured at 111.2 Fahrenheit degrees. LPA observed facility has covid precautionary postings through out the facility as well as all required Department postings. Facility has an active covid-19 prevention plan in place for the safety of all residents in care. LPA observed an ample supply of food and emergency food as well as water. First aid kits were observed in facility. LPA observed there is an ample supply of PPE, incontinence, and cleaning supplies. Facility has sanitation precaution in place through out the facility and all common spaces. LPA toured the outside and observed a gate swimming pool with a shaded patio for residents’ enjoyment. Outdoor shaded space will be used for outdoor visitation area. Facility has a plan for covid testing residents and staff as needed as well as a plan to isolation as needed. All facility bedrooms are private occupancy.

Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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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