306005978-9-13-2021-22-AS-JALE-C6TT3U-20210913142254

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005978
Report Date: 09/13/2021
Date Signed: 09/13/2021 02:23:09 PM

Document Has Been Signed on 09/13/2021 02:23 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

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: 0	DATE:	09/13/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Magdy Tawfik		TIME COMPLETED:	02:36 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Joseph Alejandre and Jerome Haley made an announced visit to conduct the pre-licensing inspection. LPAs were greeted and granted entry by Licensee/Administrator Magdy Tawfik. LPAs explained the reason for the visit. Facility is to operate an Adult Residential Facility for Develop mentally Disabled Adults, capacity is for, 4 ambulatory clients. Application was submitted to CCL on 03/11/2021. Facility phone number is 714-488-9212. LPAs and Licensee/Administrator toured the facility. Structure; Facility has 4 bedrooms and 2 bathrooms and a 2 car garage. Bathrooms; were operational and hot water measured 108.8 degrees Fahrenheit in bathroom 1 and 114.2 degrees Fahrenheit in bathroom 2. Resident Bedrooms; LPAs observed that all 4 bedrooms required new chairs. LPAs observed that each bedroom 1 through 4 had a bed with new linen, a nightstand and a lamp and a closet. All 4 bedrooms had enough space to accommodate client belongings. LPAs observed in the hall storage closet there was a hole in the ceiling for cable connections. LPAs observed that the sliding door in the hallway next to the kitchen was missing a sliding screen door. LPAs observed that the ceiling fixture in the dining room/living room had a chain and electrical cord hanging from the fixture plate. Kitchen; LPAs inspected the kitchen. The refrigerator and stove were operational. Knives were kept locked in a kitchen drawer. LPAs observed soaps and cleaning chemicals locked in a kitchen cabinet. Facility only has non-perishable food supply on hand because there are no clients at this time. Garage & Backyard; LPAs inspected the garage. The garage is kept locked and used for storage. Licensee reported the garage will be off limits to clients. LPAs observed the lighting fixture next to the garage side door was inoperable. LPAs toured the backyard. LPAs observed hanging cable from the beam connecting the roof of the garage to the roof of the house. LPAs observed the air conditioner (AC) was dripping water from the side of the house. The water is pooled around the AC unit. The backyard has two exit paths, exit 1 is a large gate the width of the driveway on the end opposite of the garage. This gate is around 20 feet long and can be opened to gain access to the driveway and the street. Exit number 2 is on the opposite side of the property and next to the garage. This passage is obstructed by a large wooden frame. The exit gate on the end of the passage is operational. There is a storage shed behind the garage that is kept locked. The shed is used for storage. LPAs observed loose bricks and blocks in the backyard.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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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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
	VISIT DATE: 09/13/2021

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LPAs observed a patio table in the backyard. LPAs observed there is no umbrella or patio structure to provide shade for the seating area outside. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were tested and all are operational. Fire extinguisher was fully charged. First aid kit inspected and had all of the required elements. Resident & Staff Files currently there is no staff and no clients, no files reviewed. Fire clearance was approved by Orange County Fire Authority Inspector Andrew Amante on 08/10/2021.

LPAs observed the following items which must be corrected. 1. All bedroom chairs must be in new or good condition (replaced). 2. Hole in hallway closet ceiling must be repaired. 3. Screen door in hallway next to kitchen was missing and must be replaced. 4. Ceiling lighting fixture cord and chain must be removed or replaced with new lighting fixture. 5. Lighting fixture on side of garage by side door must be fixed, replaced or removed. 6. AC unit is leaking and must be properly drained so no puddles or leaks are present. 7. Exit path 2 on the side of the garage must be cleaned and all objects must be removed so there are no obstacles in the path. 8. The cable hanging from the beam connecting the garage to the house must be removed or secured properly so it does not hang from the beam or the roof of the house. 9. All loose bricks and blocks must be removed from the backyard and front courtyard of the facility. 10. Facility must provide a shaded area in the backyard for the clients, the patio table must have an umbrella for shade.

The following items listed above must be corrected in order for the facility to meet Title 22 Division 6 of the California Code of Regulations.

During the visit LPA Alejandre explained the process of this application and also about post licensing visit once the facility is licensed.

Applicant was informed today that the final approval will be processed by the CAU supervisor in Sacramento.

Component III was waived during the visit due to applicant is a current licensee for a licensed ARF facility and in compliance status, supervisor approved.

An exit interview was conducted and a copy of this report, LIC809 & 809C was explained and provided to applicant Magdy Tawfik.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC809 (FAS) - (06/04)

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