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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005978
Report Date: 11/17/2022
Date Signed: 11/17/2022 11:47:40 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
03/29/2022 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220329165640
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: 3DATE:
11/17/2022
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Fionolatci CaberoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff hit a client in care.
Client was hit by another client while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegations above. LPA identified himself and discussed the purpose of the visit with staff.
The investigation into the allegations “Staff hit a client in care” and “Client was hit by another client” revealed the following:

During the unannounced facility visit October 7, 2022 LPA Haley interviewed Clinet 1 (C1) who was not interviewed during the initial investigation. During the visit LPA Haley interviewed Staff 1 (S1) regarding the allegations above. LPA Haley did not receive any information or evidence that would support or confirm the allegations above.

Based on the information gathered during the investigation, and review of all prior documents and interviews, the Department is unable to ascertain if the allegation occurred as reported.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20220329165640
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: 11/17/2022
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with staff and a copy of this report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2