565802434-5-21-2022-29-AS-EPEI-CEMQ9P-20220521115840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565802434
Report Date: 05/21/2022
Date Signed: 05/21/2022 11:59:35 AM

Document Has Been Signed on 05/21/2022 11:59 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:	PETIT OASIS		FACILITY NUMBER:	565802434
ADMINISTRATOR:	SUSANA B VINCECRUZ		FACILITY TYPE:	740
ADDRESS:	2802 PETIT STREET		TELEPHONE:	(805) 383-8894
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	6	CENSUS: 2	DATE:	05/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Susana Vincecruz, Administrator		TIME COMPLETED:	12:05 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	Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:50 a.m., LPA was greeted and screened by staff. At 10:11 a.m., the Administrator, Susana Vincecruz and the new applicant, Roberto Ramirez arrived at the facility. This annual had a specific emphasis on infection control practices and procedures. At 10:20 a.m., the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:42 a.m., hot water for both restrooms measured at 110.0 and 115.3-degree Fahrenheit. OUTDOOR SPACE: At 10:36 a.m., the LPA observed the backyard, which has a covered outdoor area for resident use. There is a gate on the side of the house that is single latched designated for an emergency exit. There are bodies of water on the premises at the time of the visit, but the pool is fenced and locked. The garage is locked and detached to the house and laundry units are located inside the garage. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed board games and magazines in the common area. The LPA observed the fire extinguishers to be fully charged and last purchased on 05/18/2022. Flashlights were observed throughout the facility. Upon entry, signs are posted to promote handwashing, cough/sneeze etiquette, and physical distancing. At 10:49 a.m., fire alarms and carbon monoxide detectors were tested and functioned properly. Continued on LIC 809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2022

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PETIT OASIS	FACILITY NUMBER: 565802434
	VISIT DATE: 05/21/2022

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KITCHEN: At 10:46 a.m., the LPA observed the kitchen/dining area. Knives are stored in a locked drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:48 a.m., hot water measured at 114.8-degree Fahrenheit. Medications and first aid kits are located in a locked kitchen cabinet. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate.

The following recommendations were made:
- Ensure that all trash bins have tight-fitting covers.
- Obtain at least 30-day supply of PPE

No deficiencies were observed at this time. Exit interview conducted with the Administrator. Report issued and a copy of the report was emailed to the Administrator.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2022

LIC809 (FAS) - (06/04)

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