<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881123
Report Date: 04/19/2021
Date Signed: 04/19/2021 04:37:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SENIOR OASISFACILITY NUMBER:
331881123
ADMINISTRATOR:APOTROSOAEI, GABRIELA MFACILITY TYPE:
740
ADDRESS:826 PASEO GRANDETELEPHONE:
(949) 306-8258
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:6CENSUS: 0DATE:
04/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gabriela ApotrosoaeiTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christine Le conducted an announced televisit due to COVID-19 to the pending facility for the pre-licensing inspection. LPA met with applicant Gabriela Apotrosoaei.

The pending application is for six (6) residents (approved for ambulatory only in rooms #1, 2, 3; nonambulatory in rooms #4, 5, 6; and bedridden in room #6) in a RCFE. LPA observed that this facility has a Dementia Care Program. LPA toured the facility inside and out. The following was observed, reviewed, and inspected: there are 6 bedrooms and 3 bathrooms. There are no bodies of water. The physical plant, in general, was in good repair. Buildings and grounds are free from hazards. Indoor and outdoor passageways are free of obstruction. There are charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. There is a locked area for medications and cleaning supplies. LPA observed a working telephone and basic laundry equipment. Resident bedrooms had the required bedding and furniture. Bedrooms had sufficient lighting. LPA observed the applicant measuring the hot water temperature in the bathrooms. The water temperature measured 111 degrees F. The facility had a sufficient amount of linen and hygiene items for the clients. In terms of the food supply, the facility had a sufficient amount of nonperishable and perishable food items. The food was kept in a safe and healthful manner. The facility menu was available for review. The freezer was 0 degrees F. The refrigerator was 45 degrees F. Dishes, glasses, and utensils were in good condition. Trash cans have tight fitting covers. The facility had a designated area for staff and resident records. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. The facility was equipped with a complete first aid kit. There is adequate seating in the common areas. Facility had a supply of activities for the clients. Night lights were maintained in the hallways. LPA also observed that auditory devices used to monitor exits were functional.

No corrections are needed to be made. An exit interview was conducted via telephone and a copy of this report was provided to the applicant via email. Report with facility representative signature was obtained.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1