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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604326
Report Date: 07/09/2020
Date Signed: 07/09/2020 04:51:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OASIS VILLAGE CAREFACILITY NUMBER:
374604326
ADMINISTRATOR:SAHID, RAMLAFACILITY TYPE:
740
ADDRESS:3865 SHIRLENE PLTELEPHONE:
(619) 723-7335
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:6CENSUS: 0DATE:
07/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:17 PM
MET WITH:Ramla SahidTIME COMPLETED:
04:45 PM
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) Kennedy conducted a Prelicensing/Component III Visit via electronic app due to COVID-19 restrictions to observe the physical plant for compliance. The LPA conducted the Component III training via Zoom and completed the physical plant inspection via FaceTime with Administrator Ramla Sahid. The LPA by observed resident accommodations including furnishings, linens and personal hygiene items; thee resident bathroom located off of hallways were equipped with non-skid bath mats; facility, resident, and staff records will be located in the locked office; food service including dishes, utensils, food storage and a seven day supply of nonperishables and a two day supply of fresh perishables are present; toxic substances are stored locked in cabinets; medication storage is in the locked office; first aid kit and current first aid manual are located in the hallway off the kitchen; activities, supplies and sufficient space to conduct are present; fire extinguishers are affixed with a current tag; smoke and carbon monoxide detectors are present and operable; facility posting requirements are present in a common area and the facility; administrators certification is current; no pool nor other body of water is present on the property, there are no guns, weapons or ammunition located on the property. Discussed with Ms. Sahid were continuing operation requirements, record keeping and physical plant compliance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application.

An exit interview was conducted with Ramla Sahid., and a copy of this report and Licensee Appeal Rights (LIC 9058) were emailed to Ms. Sahid and a return email confirms the receipt of these documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2020
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