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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005978
Report Date: 04/09/2024
Date Signed: 04/09/2024 10:08:53 AM


Document Has Been Signed on 04/09/2024 10:08 AM - 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 HOMEFACILITY NUMBER:
306005978
ADMINISTRATOR:TAWFIK, MAGDYFACILITY TYPE:
735
ADDRESS:7902 LA CASA WAYTELEPHONE:
(714) 395-4821
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:4CENSUS: 2DATE:
04/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Omar Tawfik - Administrator TIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit to follow up on an incident report dated April 3, 2024.

During the visit, LPA Haley briefly toured the interior of the facility and made observations. After touring the interior of the facility, LPA Haley spoke with Staff 1 (S1) who was present when the reported incident occurred. Administrator Omar Tawfik was also briefly interviewed upon his arrival to the facility.

As a result of today’s Case Management visit, deficiencies will be cited.

An exit interview was conducted and a copy of this report, LIC809D, LIC9102, and appeal rights were provided.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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 2


Document Has Been Signed on 04/09/2024 10:08 AM - It Cannot Be Edited

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 HOME
FACILITY NUMBER: 306005978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2024
Section Cited
CCR
80087(g)

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80087 Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.
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During the tour of the kitchen, staff placed a lock on the cabinet where the knife and scissors are kept. Administrator Tawfik will review regulation section 80087 with staff and get a signature from staff that the regulation section was reviewed and understood. Administrator Tawfik will email LPA Haley the signatures for himself and all staff by the POC due date.
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This requirement is not being met as evidenced by C1 accessing a knife on April 1, 2024 by opening an unlocked cabinet in the kitchen. During the case management visit April 9, 2024 a cabinet with a knife and a pair of sicissors was unlocked. Photos were taken. This poses an immediate 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.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2