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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 419210097
Report Date: 10/07/2024
Date Signed: 10/07/2024 04:03:32 PM

Document Has Been Signed on 10/07/2024 04:03 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 BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:OASIS HOMEFACILITY NUMBER:
419210097
ADMINISTRATOR/
DIRECTOR:
SAVOI C. EGBEFACILITY TYPE:
735
ADDRESS:924 TAFT STREETTELEPHONE:
(408) 667-6994
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 4CENSUS: 3DATE:
10/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Jeanmarie Tedonnang, House Manager, Savoi Egbe, Administrator, and Christina Youmbi, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On October 7, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the unannounced Annual 1-year required inspection. LPA Calandra was greeted by Jeanmarie Tedonnang, House Manager and explained the purpose of the visit. Savoi Egbe, Administrator and Christina Youmbi, Licensee arrived later during the visit.

LPA toured the physical plant. This is a 1-story building with 4 bedrooms, 2 bathrooms, a kitchen, living room, dining room, backyard, office, and front yard. No accessible bodies of water or hazards were observed in hallways or the front and backyards. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility's carbon monoxide and smoke alarms were observed to be in working order. The facility had the required 7 days of non perishables and 2 days of perishables. No food was expired. The facility was maintained at a comfortable temperature. The facility's first aid kit had the required items.

LPA Calandra reviewed 3 resident files and 5 staff files. All were observed to be complete.

LPA reviewed P & I monies for residents which matched the records kept at the facility.

LPA reviewed medications which matched the Centrally Stored Medication records (CSMR) kept at the facility.

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Jeanmarie Tedonnang, House Manager, Savoi Egbe, Administrator, and Christina Youmbi, Licensee and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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