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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330907269
Report Date: 02/07/2024
Date Signed: 02/07/2024 01:29:24 PM


Document Has Been Signed on 02/07/2024 01:29 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:PERRIS OASES INCFACILITY NUMBER:
330907269
ADMINISTRATOR:MARIA PLASCENCIAFACILITY TYPE:
740
ADDRESS:21222 DAWES ROADTELEPHONE:
(951) 943-2304
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:15CENSUS: 11DATE:
02/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Maria PlascenciaTIME COMPLETED:
01:30 PM
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On 2/7/2024, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conduct a required annual visit. LPA me with Administrator, Maria Plascencia who was informed of the purpose of the visit.

LPA toured the facility's interior and exterior with Administrator Plascencia, conducted staff and resident interviews and reviewed random staff and resident files. The facility has a fire clearance for 15 non-ambulatory residents and a hospice waiver for six (6). Staff present have a criminal record clearance on file and are associated with the facility. Resident files had the required documentation. During the tour, LPA observed the facility to be clean with no indoor or outdoor passageway obstructions. LPA observed the Administrator test the fire alarm system and carbon monoxide detectors, and found them to be operational. LPA observed charged fire extinguishers mounted throughout the facility. LPA toured the kitchen and observed food is stored in a safe and healthful manner. The facility had more than a 2-day supply of perishable food and 7-day supply of non-perishable food items. LPA observed emergency food and water, and Personal Protective Equipment stored in hallway cabinets. Medications are secured in medication carts, only accessible to authorized personnel such as medication technicians. Cleaning solutions and disinfectants are secured in a hallway cabinet. The facility has additional towels and linens available for the residents in care, and a fireplace with the appropriate barrier to make it inaccessible for residents. LPA did not observe bodies of water.

During today's visit, LPA did not issue any deficiencies. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Plascencia.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2024
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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