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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005978
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:42:11 PM

Document Has Been Signed on 09/27/2022 03:42 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) 395-4821
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 3DATE:
09/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Magdy TafwikTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit. LPA was greeted, granted entry, and temperature checked upon entering the facility. Facility staff called Administrator (AD) Magdy Tawfik via telephone, who arrived and was present for the visit. LPA Haley explained to AD Tawfik the reason for today's visit.

The purpose of today's visit was to conduct a Case Management visit to discuss the importance of reporting requirements. LPA Haley discussed the following with AD Tawfik:

  • COVID Reporting - A copy of the COVID script was provided.
  • Regulation 80061 Reporting Requirements - A copy of the regulation was provided .
  • LIC624 Unusual Incident/Injury Report

LPA Haley provided AD Tawfik with the Orange County Adult and Senior Care Regional Office telephone number, fax, and email address.

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

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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