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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700265
Report Date: 09/19/2022
Date Signed: 09/19/2022 01:17:24 PM


Document Has Been Signed on 09/19/2022 01:17 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OASIS FOR SENIORS AT HEAVEN'S GARDENFACILITY NUMBER:
312700265
ADMINISTRATOR:TODEREAN, ADELAFACILITY TYPE:
740
ADDRESS:6203 TWO TOWERS COURTTELEPHONE:
(916) 781-9179
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 6DATE:
09/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Adela TodereanTIME COMPLETED:
01:25 PM
NARRATIVE
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On 9/19/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility and conducted a Required 1-Year inspection. LPA met with Licensee, Adela Toderean, and explained the purpose of the inspection. Prior to today's inspection, LPA completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Upon entrance, LPA observed staff to not be masked. LPA informed Licensee all staff are to wear mask at all times in the facility. The facility currently has (6) residents and (0) resident on hospice services.

LPA and Licensee toured the interior of the facility including bathroom, (5) resident bedrooms, laundry room, kitchen and common area. LPA observed (3) residents to be in the common area, (1) resident in the dining area, and (2) residents to be in their private rooms. LPA observed paper towels, soap and hand washing signs in bathroom. LPA advised Licensee that all trash can are to have lids. LPA observed sharps, toxics and medication to be locked and secured. LPA observed the facility to have 2+ days of perishables and 7+ days of non-perishables. Fire extinguishers last serviced 9/2/2022. LPA discussed vaccination status with Licensee. LPA observed Administrator Certificate #6045732740 to be up to date. LPA reviewed 1 of 6 resident's file.

LPA requested a copy of current liability insurance, LIC 308, and LIC 500 during today's inspection by 9/30/2022. As a result of today's inspection, deficiency was observed. Please see attached LIC 809-D.

Exit interview was conducted. Copy of report and appeal rights was left at facility.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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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Document Has Been Signed on 09/19/2022 01:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926


FACILITY NAME: OASIS FOR SENIORS AT HEAVEN'S GARDEN
FACILITY NUMBER: 312700265

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited

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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by:
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Based on observation of (2) staff not wearing mask in the facility, Licensee did not comply with the section cited above that all staff are to wear maks regardless of vaccination status which poses/posed a potential health, safety or personal rights risk to persons in care.
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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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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