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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604587
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:27:30 PM

Document Has Been Signed on 09/08/2022 03:27 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OASIS VILLAGE CARE #2FACILITY NUMBER:
374604587
ADMINISTRATOR:SAHID, RAMLAFACILITY TYPE:
735
ADDRESS:12712 ROBISON BLVD.TELEPHONE:
(619) 727-7335
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 4CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Ramla Sahid, AdministratorTIME COMPLETED:
01:21 PM
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Licensing Program Analyst (LPA) Esther Miller conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of California Code of Regulations and Health & Safety Code. LPA was met and granted entry by Ramla Sahid, Administrator. The facility's fire clearance was granted on July 26, 2022 and reflects that the facility is approved for four (4) bedridden residents.

During today's visit, LPA, accompanied by Samsam Khalif and Administrator, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Residents' bedrooms were observed to be clean and ready for occupancy. Toilets were found to be in working order. Facility temperature was 77 degrees F during the visit. Water temperature in bathroom measured at 130.8, 131.2, and 132.1 degrees F. LPA observed locked cabinets and closets in which hazardous and/or toxic chemicals will be stored and secured. There is a locked cabinet for storage of medications and resident records. Staff records will be stored in locked storage room. There is also a complete first aid kit present in the facility. Activities and sufficient space in which to conduct activities are present. Smoke and carbon monoxide detectors are hard-wired, were recently inspected by the local fire authority, and found to be in working order. No pools or bodies of water were observed near or on the premises. According to the applicant, no firearms and/or ammunition are present or will be stored in the facility. Ample and appropriate storage was present to store perishable and non-perishable food items. Non-perishable food items were present for future resident use. Required postings were not observed in a visible area of the facility.

Items reviewed during today's visit are not in compliance with Title 22, Division 6 of California Code of Regulations and applicant has not passed the pre-licensing inspection. Component III was completed during today’s visit. Applicant was advised that the application will require further review and a follow-up visit. This report was discussed with the applicant, and a copy of the report and Applicant Rights (LIC 9058) will be provided following the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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