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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005978
Report Date: 10/02/2024
Date Signed: 10/02/2024 12:23:01 PM

Document Has Been Signed on 10/02/2024 12:23 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 HOMEFACILITY NUMBER:
306005978
ADMINISTRATOR/
DIRECTOR:		TAWFIK, MAGDYFACILITY TYPE:
735
ADDRESS:7902 LA CASA WAYTELEPHONE:
(714) 395-4821
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 4DATE:
10/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Magdy Tawfik- AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Care Staff Hassan Muhidin after explaining the reason for the visit. Administrator (Admin) Omar Tawfik arrived shortly as well Magdy Tawfik.

The facility is a single story home located in a residential neighborhood. Facility offers at a Service level 4I. and is licensed to serve four (4) ambulatory clients. The client census is four and two staff are on duty.

LPA conducted the tour of the physical plant accompanied by Administrator Omar. Facility consists of four client bedrooms and two client bathrooms. LPAs observed the facility to be clean, sanitary, and in good repair. The common areas were inspected including the attached two car garage which is used as storage. The clients' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The water temperature measured at 116.6 and 114.6 degrees Fahrenheit. The indoor temperature was within a comfortable range. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPAs observed adequate supply of two day perishables and seven day non-perishable food. LPAs toured the outside grounds. LPAs observed the outdoor passageway free of obstruction. The exit driveway gate was operational. LPA observed sufficient seating and shading in the back yard. Facility maintains a fire extinguisher which was mounted, charged, and serviced on January 22, 2024. The dual functioning smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency disaster supplies including food/water. The first aid kit contains all necessary elements. Emergency evacuation drills are conducted evidenced by the emergency drill logs. A working facility telephone number, (714) 395-4821, remains available.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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Document Has Been Signed on 10/02/2024 12:23 PM - It Cannot Be Edited


Created By: Jessica Cho On 10/02/2024 at 11:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: OASIS HOME
FACILITY NUMBER: 306005978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(a)(10)
Personnel Records 80066 (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (10) A health screening as specified in Section 80065(g).


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the health screening (LIC503) was incomplete in one out of the two staff which poses a potential Health, Safety, or Personal Rights risk to persons in care.
POC Due Date: 10/08/2024
Plan of Correction
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Administrator stated that the completed LIC503 form will be sent to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Lourdes Montoya
LICENSING EVALUATOR NAME:Jessica Cho
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: OASIS HOME
FACILITY NUMBER: 306005978
VISIT DATE: 10/02/2024
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During today's visit, LPA conducted an audit of four client files and two personnel files. No discrepancies with client files. The Health Screening Report (LIC503) was incomplete in one out of two staff files reviewed. Medications were audited for four clients. No discrepancies noted. The Personal & Incidental (P&I) Funds were audited. No discrepancies noted. LPA observed available funds (petty cash) maintained at the facility for the client to use. Interviews were conducted with two out of the four clients. Staff were unavailable to interview as staff were attending to the clients.

The administrator was advised to ensure all records are readily available for review at all times and to ensure the required personnel records such as the LIC503 is completed for each working staff

Based on the observations made during today's visit, a deficiency is being cited. Technical Advisories are being issued.

An exit interview was conducted with Administrator Magdy Tawfik, and a copy of this report along with the LIC9099-C, LIC9099D, and the appeal rights were provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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