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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801734
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:12:00 AM


Document Has Been Signed on 03/21/2024 11:12 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:OANI HOME CARE FOR THE ELDERLY, INC.FACILITY NUMBER:
425801734
ADMINISTRATOR:SHIRLEY C. OANIFACILITY TYPE:
740
ADDRESS:936 N. SENECA STREETTELEPHONE:
(805) 354-0983
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 5DATE:
03/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Administartor, Shirley OaniTIME COMPLETED:
12:03 PM
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At 9:00am on 03/21/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Administrator, Shirley Oani, announced who he is and the reason for the visit.

This is a 5 bedroom 3 bathroom facility, 4 bedrooms are resident bedrooms and 1 bedroom is a staff room. LPA and Administrator conducted a walking tour of the facility. LPA noted that there is a nice back yard with a covered pergola for shade for residents and visitors. LPA noted that the grass area is unfinished and awaiting local county approval for landscaping to finish. LPA noted that there are smoke detectors and a carbon monoxide detector working and located throughout the facility. LPA noted that there is a working fire extinguisher in the kitchen. LPA noted that there resident rooms are lighted and furnished with regulation standards. LPA noted that all walkways, doors and exits are free and clear of obstacles and debris. LPA noted that there is at least 2 days of perishable and at least 7 days of non-perishable foods on hand at the facility. LPA noted that generator and emergency water are located in the facility garage. LPA conducted a cursory medication audit with no issues. LPA reviewed sample staff records and current training with no issues. LPA reviewed resident files and found no issues. LPA noted that the facility is clean and in good repair and found no issues on the facility walking tour. LPA noted that there were no violations, citations, or technical issued as a result of the facility walk through.

Administrator and LPA conducted a full review of the annual care tools. LPA noted that there were no technical, violations, or citations issued as a result of the annual full review of the care tools. LPA noted that there were no citations, violations, or technical issued as a result of the full annual inspection.

Exit interview, report read, and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
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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