<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005614
Report Date: 06/19/2024
Date Signed: 06/19/2024 02:40:59 PM


Document Has Been Signed on 06/19/2024 02:40 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
ORANGE COUNTY RO, 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:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Hermelinda PerezTIME COMPLETED:
02:45 PM
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) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with the Administrator and explained the reason for the visit. The Administrator, Hermelinda Perez's Administrator's certificate expires on October 30, 2024. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the entry way of the facility. The facility is a single story home with 6 bedrooms, 2 bathrooms, living room, eat in kitchen and a 2 car garage. LPA observed the fireplace in the living room is screened. LPA toured the kitchen. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The 4 burner gas stove lights unassisted. LPA observed the knives are kept locked in the garage. LPA observed the fire extinguisher in the kitchen is fully charged. LPA toured the resident rooms. LPA observed all resident rooms are clean and organized. All resident beds had the required linens. LPA observed both bathrooms are clean and operational. How water measured 109.0 degrees Fahrenheit in both bathrooms. LPA toured the garage. The garage is used for storage and kept locked. LPA observed extra furniture, supplies and perishable food stored in the garage refrigerator. The living room has chairs and a couch for residents to sit and there is a TV mounted above the fireplace for residents to watch TV. LPA observed the medication is stored in the locked in a hallway closet. LPA toured the backyard. LPA observed a covered patio in the backyard. There is a pool in the backyard which is surrounded by a fence that measures 60 inches tall. The pool gate is secured and the pool is inaccessible to residents. The backyard exit gate is operational and is self closing. There is storage room next to the garage that is used to store old furniture and wheelchairs. No obstacles or hazards observed inside or outside of the facility. LPA reviewed 2 staff files, no discrepancies observed. The 2 staff had the required 20 hours of annual training. LPA reviewed 6 resident files and medications, no discrepancies observed. Smoke detectors/carbon monoxide detectors tested operational. No deficiencies observed during the visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1