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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005978
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:58:05 PM

Document Has Been Signed on 09/15/2022 03:58 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 HOMEFACILITY NUMBER:
306005978
ADMINISTRATOR:TAWFIK, MAGDYFACILITY TYPE:
735
ADDRESS:7902 LA CASA WAYTELEPHONE:
(714) 458-9593
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 2DATE:
09/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:F. CaberoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management. LPA was greeted, granted entry and explained the reason for the visit.

The purpose of today's visit was to conduct a Case Management visit to discuss an Unusual Incident Report (LIC 624) that was sent to the Orange County Adult and Senior Care Program Regional Office September 13, 2022 that involved Client 1 (C1). LPA Haley spoke with Administrator (AD) Magdy Tawfik and Assistant Administrator Omar Tawfik via telephone.

During the visit LPA Haley received AD Omar emailed copies of C1's Admission Agreement, Physician's Report, Face sheet, and Individualized Service Plan.

No deficiencies are being cited during today's Case Management visit. An exit interview was conducted and a copy of this report and LIC 811 was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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