374604851-10-17-2024-08-AS-THOS-DA5PW2-20241017114000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604851
Report Date: 10/17/2024
Date Signed: 10/17/2024 11:40:07 AM

Document Has Been Signed on 10/17/2024 11:40 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	OASIS SPRINGS		FACILITY NUMBER:	374604851
ADMINISTRATOR/ DIRECTOR:	HUSSEIN, ABDIAZIZ		FACILITY TYPE:	735
ADDRESS:	2342 HELIX ST		TELEPHONE:	(619) 727-7335
CITY:	SPRINGS VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY: 4		CENSUS: 0	DATE:	10/17/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:50 AM
MET WITH:	Abdiaziz Hussein, Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:48 AM

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to the applicant’s representatives, Abdiaziz Hussein, Administrator.

The facility fire clearance was granted on 08/16/2024 and reflected that the facility was approved for four (4) clients in total, of which may be ambulatory with one (1) may be bedridden/non ambulatory in bedroom 4 only. The submitted facility sketch was consistent with the current layout of the facility.

During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Toilets and sinks were in working order. The facility’s ambient internal temperature was complaint at 68 degrees F. Hot water temperature in bathrooms that were accessible to clients were also compliant reading at 113.2 F.

The facility has enough perishable and non-perishable food for future client use. All kitchen appliances were in working order. Refrigerator temperature and freezer temperature was adequate.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OASIS SPRINGS	FACILITY NUMBER: 374604851
	VISIT DATE: 10/17/2024

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[CONTINUED FROM LIC 809]

The facility has sufficient space and equipment to facilitate visitation, meetings, and client activities. The facility has locked areas for storage of medication and confidential resident and staff records.

No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, or open-faced heaters accessible to clients. The fireplace will be boarded up by next week. Per the applicant’s representatives, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguishers were serviced within the last 12 months. A complete first aid kit was available. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also provided the Component III Training during today’s visit. Abdiaziz Hussein, Administrator were advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with the applicant’s representatives, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024

LIC809 (FAS) - (06/04)

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