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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005614
Report Date: 05/13/2022
Date Signed: 05/13/2022 04:06:11 PM


Document Has Been Signed on 05/13/2022 04:06 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
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:
05/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Hermelinda Perez - AdministratorTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to The Oasis. The purpose of today's visit was to conduct a Required 1 Year inspection focusing primarily on Infection Control. LPA Velazquez was allowed entry into the facility and met with Caregiver (CG) Maria Gutierrez. CG Martin Robles was also present. Administrator Hermelinda Perez arrived shortly after LPA's arrival. The facility is licensed for 1 ambulatory and 5 non-ambulatory residents. The facility also has a Hospice waiver for 3 residents. There are currently 6 residents living in the facility. Per Administrator Perez the facility has not conducted a recent emergency disaster drill.

At 2:50 PM LPA Velazquez conducted a tour of the physical plant along with Administrator Perez. The 1 story home consists of 5 resident bedrooms with 2 bathrooms. The facility also has a living room, dining area, and kitchen. LPA Velazquez observed the Complaint poster was not in the correct size and Administrator Perez indicated she has ordered the poster in the correct size. The 6 residents in the facility appeared well-groomed and well cared-for. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. Resident bath towels and personal hygiene supplies were adequately stocked. LPA Velazquez tested the hot water temperature in the resident bathrooms and the temperature measured at 111.5 degrees Fahrenheit in the first bathroom and at 111.3 degrees Fahrenheit in the second bathroom.

LPA Velazquez inspected the kitchen along with Administrator Perez. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. The fire extinguisher was fully charged. The smoke and carbon monoxide detectors were tested and found to be operational. Medications, toxins and sharps were locked and inaccessible to residents. The auditory alarms throughout the facility were in operating condition.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: OASIS, THE
FACILITY NUMBER: 306005614
VISIT DATE: 05/13/2022
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LPA Velazquez along with Administrator Perez toured the outside grounds. There was a swimming pool that is surrounded by a fence that is locked at all times and inaccessible to residents. There was shading and sufficient seating for residents. Walkways around the home were clear of hazards and the exit gate did not have a self-closing latch. There were no security bars or weapons on the premises.

No resident or staff files were reviewed at the time of this visit.



There were no deficiencies issued during this 1 Year Required inspection. An exit interview was conducted with Administrator Perez and a copy of this report along with the a copy of the LIC 9102s were provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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