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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002695
Report Date: 02/19/2025
Date Signed: 02/27/2025 08:38:50 AM

Document Has Been Signed on 02/27/2025 08:38 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:OASIS GUEST HOMEFACILITY NUMBER:
397002695
ADMINISTRATOR/
DIRECTOR:		BRANDON ROSEFACILITY TYPE:
740
ADDRESS:9207 MAMMATH PEAK CIRCLETELEPHONE:
(209) 565-5472
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Brandon RoseTIME VISIT/
INSPECTION COMPLETED:
01:00 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
Unannounced Annual Licensing visit made out to this facility on 02/19/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Brandon Rose, at this time. A brief interview was conducted with the facility designated Administrator at this time.
This facility is licensed to serve up to (6) Non Ambulatory residents at any given time.
Current census was 6 residents.
It was learned that there were (2) residents under the care of hospice at this time. This facility was approved to be able to accept and retain up to (4) residents at any given time.
It was learned that there was (1) resident deemed to be bedridden at this time. The facility was approved to be able to accept and retain up to (1) resident deemed to be bedridden at any given time.
Tour of this facility was conducted.
A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time.
Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time.
A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times.
Medication cabinet, located in the kitchen cabinet, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator member at this time. A review of the facility Medication Administration Record and dispensing log was conducted.
Medication cabinet was observed to be locked and made inaccessible to the residents at this time.
Living room, dining area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time and able to meet the needs of the residents.
Liza KingTELEPHONE: (650) 676-0442
Charlie YangTELEPHONE: (916) 709-6507
DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OASIS GUEST HOME
FACILITY NUMBER: 397002695
VISIT DATE: 02/19/2025
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
26
27
28
29
30
31
32
A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
A tour of the resident restroom was conducted.
Hot water temperature was taken to make sure that it measured within the allowed range of 105-120 degrees at all times.
Laundry room, located prior to the garage door exit, was toured. Cleaning supplies, detergents, and bleach were observed to be locked and made inaccessible to the residents at this time.
Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time.
A tour of the garage area was conducted. It was learned that this area was mainly used as a storage space for facility related items at this time.
First aid kits were observed to be present and contained all of the required components at this time.
Fire extinguishers were observed to have been annually reviewed on 02/19/2025 from the local fire extinguisher company, Jorgensen Fire, and observed to be in compliance at this time.
Administrator certificate for Brandon Rose was observed to have an expiration date of 06/04/2024 with certificate #6031277740. All updated forms and documents have been submitted to renew at this time with certification dated 04/12/2024.
A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted.
A review of (4) facility resident files was conducted and noted on the following LIC 858.
A review of (5) facility staff files was conducted and noted on the following LIC 859.

This LPA requested that this facility, and its representative, update the following forms and submit them into CCL for review by this LPA:

LIC 308, LIC 400, LIC 500, LIC 610

The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes.

Appeal rights were reviewed and a copy was printed and given to the facility designated Administrator at this time. Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/27/2025 08:38 AM - It Cannot Be Edited


Created By: Charlie Yang On 02/19/2025 at 12:23 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OASIS GUEST HOME
FACILITY NUMBER: 397002695

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87470(c)(1)(C)3
Infection Control Requirements
(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. 3. The description of initial and ongoing training shall address the requirements of subsections (a), (b) and (d).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in that [4] out of [5] facility personnel files did not have updated training on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2025
Plan of Correction
1
2
3
4
The facility designated Administrator stated that all facility staff providing care and supervision to the residents in care will receive the required hours of initial and ongoing training. A statement of correction, along with proof of updated Infection Control Training, will be completed and submitted into CCL by the due date.
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in [4] out of [5] facility personnel folders did not have required annual training hours on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2025
Plan of Correction
1
2
3
4
The facility designated Administrator stated that all facility staff providing care and supervision to the residents in care will receive the required hours of annual training. A statement of correction, along with proof of updated annual training, will be completed and submitted into CCL by the due date.
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:Liza King
TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME:Charlie Yang
TELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/27/2025 08:38 AM - It Cannot Be Edited


Created By: Charlie Yang On 02/19/2025 at 12:29 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OASIS GUEST HOME
FACILITY NUMBER: 397002695

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that facility furniture, drawers, and cabinets were in need of repair to be maintained in compliance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2025
Plan of Correction
1
2
3
4
The facility designated Administrator stated that all cabinets, drawers, and facility furniture will be reviewed and any that are observed to be in need of repair/replacement will be completed as required at this time. A statement of correction, along with photos of updated cabinets, drawers, and furniture will be completed and submitted into CCL by the due date.
Type B
Section Cited
CCR
87303(c)

All window screens shall be clean and maintained in good repair.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that several window screens were ripped, torn, or had holes in them which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/26/2025
Plan of Correction
1
2
3
4
The facility designated Administrator stated that a review of all window screens and screen doors will be reviewed to make sure that any with holes, rips, or tears in them will be repaired/replaced as necessary. A statement of correction, along with photos and receipt of contracted work, will be completed and submitted into CCL by the due date.
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:Liza King
TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME:Charlie Yang
TELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4