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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600280
Report Date: 01/26/2022
Date Signed: 01/26/2022 01:02:43 PM

Document Has Been Signed on 01/26/2022 01:02 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:OASIS HOMEFACILITY NUMBER:
197600280
ADMINISTRATOR:VON BUCK, CLIFTONFACILITY TYPE:
740
ADDRESS:1003 WEST AVE. H-4TELEPHONE:
(661) 948-9594
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 4CENSUS: 4DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Faith KemamziTIME COMPLETED:
01:15 PM
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LPA Spaeth conducted an unannounced visit to the facility and was greeted by caregiver, Faith Kemamzi. Upon approaching the front door of the facility, LPA observed the COVID signs. Administrator and the four residents were all wearing a mask. Caregiver recorded LPA's temperature and requested LPA sign in. LPA observed the sign in station which contained thermometer, masks, sign in sheet, and hand sanitizer.

LPA and Caregiver began the tour at 11:45 am. LPA observed two residents sitting in the living room, were social distanced, and both residents were watching television. LPA observed the dining room which contained dining table and chairs. The laundry room was next to the dining room. When entering the kitchen, LPA observed the kitchen was nice and clean. The knives, cleaning supplies, and laundry detergent were locked underneath the sink. LPA observed wash your hands sign, hand soap, paper towels, and a trash can.

The refrigerator was stocked with three day supply of fresh vegetables, fruit, and eggs. There was an adequate supply of frozen meats in the freezer. LPA observed a seven day supply of canned goods and pasta. LPA observed snacks available in the dining room and a plate of cookies. Upon entering the hallway, LPA observed a hallway closet which contained the locked medications. LPA observed the resident bathroom which was clean and contained hand soap, hand dryer, covered trash can, wash your hands sign. The caregiver demonstrated the hand dryer was working and is used instead of paper towels. The bathroom also contained grab bars.

LPA observed three of the four residents. All rooms contained bed, linens, chair, night stand, and light. All rooms were neat and clean. LPA was then escorted to the locked garage and LPA observed two refrigerators and a freezer all stocked with food. LPA observed a six month supply of PPE which was provided by the North L/A Regional Center. LPA observed comfortable seating in the backyard and the side gate was unlocked.

There are no deficiencies to report at this time. Exit interview was conducted, appeal rights discussed, and a copy of the signed document was provided to the caregiver.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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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