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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002709
Report Date: 09/10/2024
Date Signed: 09/10/2024 10:39:29 AM

Document Has Been Signed on 09/10/2024 10:39 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:OASIS RESIDENTIAL - GRANADAFACILITY NUMBER:
455002709
ADMINISTRATOR/
DIRECTOR:		DOOLEY, JOELFACILITY TYPE:
735
ADDRESS:7224 GRANADA DRTELEPHONE:
(530) 646-8892
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 3CENSUS: 2DATE:
09/10/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Kyle BurgesTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On 09/10/2024, Licensing Program Analyst (LPA) Ivan Avila arrived unannounced at the facility to conduct a case management visit regarding an absent without leave incident report the Department received via fax on 09/02/2024. LPA met with Administrator Kyle Burges and explained the purpose of the visit.

The incident occurred on 08/31/2024 when C1 eloped from the facility at approximately 2:30 PM on his bike. Staff could not get a hold of C1 until 8:33 PM when C1 sent a text message to Administrator stating he did not want to return. Law enforcement was contacted at approximately 8:50 PM to inform them about the elopement. C1 was later found 10 miles away on 09/03/2024 when he was picked up at a local restaurant and driven back to the facility. C1 had been away from the facility for a few days and during that time C1 did not receive his medications.

Although no injuries resulted from C1’s AWOL, client was missing from the facility for three days. C1 also missed his nightly medications. Facility currently does not have an updated physician report (LIC 602).

LPA and Administrator discussed the importance of contacting the Administrator as soon as a client elopes the facility and alerting local law enforcement in a timely manner. LPA and Administrator also discussed the importance of obtaining an updated physician report per licensing guidelines when there's a change of condition.

As a result of the incident, a deficiency is being cited per California Code of Regulations, Title 22, and California Health and Safety Code. The deficiency is documented on the LIC 809-D page.



Exit interview conducted, a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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 09/10/2024 10:39 AM - It Cannot Be Edited


Created By: Ivan Avila On 09/10/2024 at 10:09 AM
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 RESIDENTIAL - GRANADA
FACILITY NUMBER: 455002709

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2024
Section Cited
CCR
85065(b)

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85065(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.
This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 85065(b). Facility will submit statement of understanding to LPA by POC due date of 09/13/2024.
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Based on file review and interview, the Licensee did not comply in the section cited above as client eloped the facility and did not ensure the care and supervision to meet client needs, which poses an immediate health, safety, and personal rights risk to clients in care.
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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:Anthony Perez
LICENSING EVALUATOR NAME:Ivan Avila
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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