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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604587
Report Date: 09/30/2024
Date Signed: 09/30/2024 01:48:26 PM

Document Has Been Signed on 09/30/2024 01:48 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OASIS VILLAGE CARE #2FACILITY NUMBER:
374604587
ADMINISTRATOR/
DIRECTOR:		SAHID, RAMLAFACILITY TYPE:
735
ADDRESS:12712 ROBISON BLVD.TELEPHONE:
(619) 727-7335
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 4CENSUS: 4DATE:
09/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Caregiver Nimo HassanTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ryan Fulton conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Caregiver Nimo Hassan. The facility's license shows a maximum capacity of Four (4) clients. During today’s inspection there were Four (4) clients in care.

LPA and caregiver Nimo Hassan toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. clients’ bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all of which are safely stored. Cooking/dining equipment and utensils were present. Toxic chemicals/poisons were locked and inaccessible to clients. Medications were labeled, as required, and stored in locked areas. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 109.6 F; bathroom #1 sink was 111.2 F and bathroom #2 sink was 112.3 F.

No pools or bodies of water exist on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide/Smoke detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

Deficiency was cited today LPA Fulton observed that C1 has oxygen in use in their bedroom but no oxygen in use sign posted outside their door. An exit interview was conducted with Caregiver Nimo Hassan to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Ryan Fulton
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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Document Has Been Signed on 09/30/2024 01:48 PM - It Cannot Be Edited


Created By: Ryan Fulton On 09/30/2024 at 01:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OASIS VILLAGE CARE #2
FACILITY NUMBER: 374604587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(e)(2)(B)
Health-Related Services
(e) In adult CCFs, when a client requires oxygen the licensee is responsible for the following: (2) Ensuring that the following conditions are met if oxygen equipment is in use: (B) "No Smoking - Oxygen in Use" signs shall be posted in appropriate areas.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above LPA observed that C1 had no oxygen in use sign posted in [1] out of [1] persons in care which posed a potential safety risk to persons in care.
POC Due Date: 10/01/2024
Plan of Correction
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Licensee agreed to post a Non smoking sign outside of C1's bedroom. Before LPA left the facility Licensee posted the non smoking sign in front of C1's bedroom
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jennifer Lott
LICENSING EVALUATOR NAME:Ryan Fulton
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024


LIC809 (FAS) - (06/04)
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