306005978-9-22-2022-22-AS-LADS-CJRNDJ-20220930102223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005978
Report Date: 09/22/2022
Date Signed: 09/22/2022 10:06:54 AM

Unsubstantiated

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
03/25/2022 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220325160039

FACILITY NAME:	OASIS HOME		FACILITY NUMBER:	306005978
ADMINISTRATOR:	TAWFIK, MAGDY		FACILITY TYPE:	735
ADDRESS:	7902 LA CASA WAY		TELEPHONE:	(714) 458-9593
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	4	CENSUS: 3	DATE:	09/22/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator (AD) Magdy Tawfik		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff failed to provide adequate supervision resulting to a client swallowing a foreign object.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit in facility to deliver the findings for the investigation completed for complaint filed last March 29, 2022 against this facility. Via phone, LPA spoke with Administrator (AD) Magdy Tawfik, stated the purpose of the visit, and discussed the findings.

On allegation that the facility staff failed to provide adequate supervision resulting to a client swallowing a foreign object, the following are the findings. Client 1 was admitted in the facility last March 3, 2022. Per October 21, 2021 Individual Service Plan, Client 1 had diagnosis that include mild intellectual disability unspecified mood disorder, intermittent explosive disorder. In July 2021, Client had history of ingested foreign object that resulted to intestinal obstruction and placement of ileostomy. C1 also had a behavior to cause injury or harm to self to seek attention or force staff to seek emergency consult. On the day of the incident, C1 was agitated toward staff members and refused medications. C1 requested to be alone ; and moments after reported to staff about ingestion of foreign object. AD immediately brought C1 to emergency room for consult and was subsequently admitted. Review of medical records revealed that C1 continued injurious behavior to keep self from being discharge. (Continuation in Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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-20220325160039

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
	VISIT DATE: 09/22/2022

NARRATIVE

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Continuation from Page 1

LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.
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LPA Marin conducted a phone exit interview with AD Tawfik. AD gave permission for staff to sign and receive this report. Copy of this report was left in the facility.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC9099 (FAS) - (06/04)

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