335530129-8-3-2023-56-AS-RGAR-CUCNRQ-20230803104155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 335530129
Report Date: 08/03/2023
Date Signed: 08/03/2023 10:42:07 AM

Document Has Been Signed on 08/03/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SENIOR OASIS 2		FACILITY NUMBER:	335530129
ADMINISTRATOR:	APOTROSOAEI, GABRIELA		FACILITY TYPE:	740
ADDRESS:	18780 STATE STREET		TELEPHONE:	(949) 306-8258
CITY:	CORONA	STATE: CA	ZIP CODE:	92881
CAPACITY:	6	CENSUS: 0	DATE:	08/03/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gabriela Apotrosoaei- Administrator		TIME COMPLETED:	10:51 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) Ryan Gardner conducted an announced visit to complete the Pre-licensing inspection. LPA met with Administrator Gabriela Apotrosoaei for a Residential Care Facility for for five (5) non- ambulatory residents and one (1) bedridden resident. The fire clearance was approved by the fire department on 5/11/2023. The facility has seven (7) bedrooms and four (4) bathrooms. There are six (6) resident bedrooms, one (1) staff bedroom, a kitchen/dining area, one (1) main living room area, a backyard with a fenced in/locked pool and spa, and an attached garage with a washer and dryer. LPA toured the interior and exterior areas of the facility. The following were inspected: Resident Bedrooms: All bedrooms have the required bedding and furniture, such as, clean mattresses/linen, nightstands, dressers, chairs, and lighting. The bedrooms with exterior doors have an alarm when the door is opened. Resident Bathrooms: The bathrooms appliances were operating in safe and sanitary condition. The water temperature was measured by LPA, the thermometer read at 105.1 degrees F. Kitchen and Dining Areas: Utensils and dishware are in good repair and ready for resident use. Kitchen appliances and countertop were free of debris and in good repair. The refrigerator was measured at 40 degrees F and the freezer was measured at 0 degrees F. The knives, sharps, and location for medications were safely locked and secured. The facility has a posted meal schedule. Common Sitting Areas: There is adequate seating in the common areas. The facility has a supply of activities for the residents. The facility has posted an activity schedule.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SENIOR OASIS 2	FACILITY NUMBER: 335530129
	VISIT DATE: 08/03/2023

NARRATIVE

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Garage/Laundry: The laundry room is in the garage. The chemicals and laundry soap were safely locked in this room.

Linens and Hygiene Supplies: An adequate supply of linens was available in each resident bedroom.

Backyard: There is a fenced in and locked pool and spa. There is a covered area with seating for the all the residents. All passageways were free from obstruction.

Fire extinguisher, carbon monoxide, firearms: There were two (2) charged fire extinguishers in the facility. LPA observed operating smoke detectors and carbon monoxide alarms. The home does not have any firearms and ammunition.

Postings: LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, labor laws, and personal rights.

First aid and working telephone: The facility was equipped with a complete first aid kit and manual. The facility has working telephone for resident use.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA have determined that the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete, and the facility has no deficiencies. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations.

The required Comp III presentation was completed. An exit interview was conducted, and this report was discussed and provided to Administrator Gabriela Apotrosoaei.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

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