306005978-10-14-2022-22-AS-JHAY-CK7TYE-20221014150838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005978
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:08:48 PM

Document Has Been Signed on 10/14/2022 03:08 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) 395-4821
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY: 4		CENSUS: 4	DATE:	10/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Magdy Tawfik		TIME COMPLETED:	03:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Administrator (AD) Magdy Tawfik arrived after the visit started. Administrator Omar Tawfik has a current administrators certificate that expires 03/08/23. LPA Haley was temperature screened upon entering the facility.

At 12:15 PM LPA Haley and staff began the inspection at the entrance of the facility. There were four clients present during the visit. LPA Haley observed a closet near the front door that's used for the staffs personal items: shoes, clothing, and work bags.

Clients bedrooms were clean, organized, and had all necessary requirements: night stand, chair, lamp and storage space. In client bedroom #1 there was a broken television. LPA advised staff and AD Tawfik on the importance of everything in the facility being in good working condition. The client bathroom was clean and organized. Hot water temperature was measured at 105.2 degrees Fahrenheit. In the hallway near bedroom #2 LPA observed a cabinet used to store a broom, dust pan, pads and diapers.

In the living room LPA observed a screening station with a temperature thermometer, N95 face mask, surgical mask, gloves, and hand sanitizer. There's a locked file cabinet used to store client medication, and a first aid kit with all the required elements. At 12:28 PM while in the living room LPA observed a broken television. Again, staff and AD Tawfik were advised everything in the facility needs to be in good repair.

In the kitchen LPA observed the following: All hazardous chemicals were locked under the kitchen sink. Knives and sharp objects locked in a drawer next to the stove. All burners on the stove were operational. LPA Haley observed a 2 day supply of perishable food items and a 7 day supply of non-perishable food items.

Continued on LIC809C Dated 10/14/22

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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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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: 10/14/2022

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Above the refrigerator LPA Haley observed an unlocked cabinet with chemicals accessible to clients in care. LPA observed Homebright Disinfectant Sprays, Lysol, and air fresheners. LPA Advised staff the importance of keeping hazardous items locked and inaccessible to clients at all times. As you exit out the kitchen, LPA Haley observed a washer and dryer. Above the washer and dryer are two locked cabinets used to store detergents.

The backyard clean and free of clutter. Walkways were clear and free of tripping hazards. LPA Haley observed a table with chairs and a sunshade that was removed due to the wind and rain. There was a locked storage shed in the back used to store miscellaneous items. LPA observed bricks, a TV, boxes, and some tools in the locked shed.

The garage was organized and free of clutter. LPA observed a emergency water supply and cleaning supplies. The garage remains locked and inaccessible to residents in care.

In client bedroom number # LPA observed a bathroom that was unlocked and accessible to residents in care. In the bathroom LPA observed a cabinet under the sink with hazardous chemicals accessible to the clients in care. At 12:53 PM LPA observed cans of Lysol, Air Freshener, and hazardous cleaning spray unlocked under the sink. LPA also observed disinfectant wipes sitting on the sink. Again, LPA Haley advised staff and AD Tawfik the importance of keeping hazardous chemicals locked and inaccessible to clients at all times. AD Tawfik stated that the bathroom was for staff; however, it was unlocked and in the room of another client.

An Advisory Notes: Technical Violation was issued for the broken television in the living room and client room. AD Tawfik has a working TV in the storage shed in the back yard that will be used as a replacement for one of the broken TVs.

Deficiencies are being cited during todays visit. An exit interview was conducted and a copy of this report, LIC809D, LIC9102 (Technical Violation), and appeal rights were provided to Administrator Magdy Tawfik.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/14/2022 03:08 PM - It Cannot Be Edited

Created By: Jerome Haley On 10/14/2022 at 02:34 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: OASIS HOME	FACILITY NUMBER: 306005978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(g)

80087 Building 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, of unlocked disinfectant sprays, disenfectant wipes, cleaning spray, and air freshiners above the refridgerator, and in client bathroom #2, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care.
	POC Due Date: 10/14/2022
	Plan of Correction
1 2 3 4	Licensee removed the hazardous items from above the refridgerator and client bathroom #2. Licensee locked all the hazardous itmes in the lock garage. LPA Haley confirmed the items were removed at the end of the visit. AD Tawfik understands the importance of hazardous items remaining locked and inaccessible to clients at all times.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Adams

LICENSING EVALUATOR NAME:

Jerome Haley

LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC809 (FAS) - (06/04)

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