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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005978
Report Date: 06/21/2022
Date Signed: 06/21/2022 03:21:23 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2022 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220615142756
FACILITY NAME:OASIS HOMEFACILITY NUMBER:
306005978
ADMINISTRATOR:TAWFIK, MAGDYFACILITY TYPE:
735
ADDRESS:7902 LA CASA WAYTELEPHONE:
(714) 458-9593
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:4CENSUS: 2DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Magdy TawfikTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Jerome Haley and Joseph Alejandre made unannouced visit to this facility to intiatate the investigation for the complaint received against this facility on June 15, 2022. LPAs were greeted, granted entry by staff and explained the reason for the visit.

LPA's interviewed staff and Administrator (AD) Tawfik regarding the complaint allegation. The investigation revealed the following: LPAs observed a broken center window in the living room is broken and cracked.The center window is currently covered with plastic and tape. LPAs observed a broken window in bathroom number 1 that is covered with plastic and tape. LPAs observed a broken window in the rear entry way that has also been covered with Plastic and tape. Administrator Tafik stated the windows have been broken for at least a week. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6, Chapter 1. An exit interview was conducted with Administrator Tafik and a copy of this report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 22-AS-20220615142756
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 HOME
FACILITY NUMBER: 306005978
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2022
Section Cited
CCR
80087
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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not being met as evidenced by:
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Licensee agrees to submit proof of purchase of new windows and materials to fix the broken windows to LPA by POC due date.
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LPAs observation of three broken windows that are currently covered with plastic and tape. This poses a potiental safety risk to clients 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.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
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