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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610539
Report Date: 03/20/2024
Date Signed: 03/20/2024 03:37:54 PM

Document Has Been Signed on 03/20/2024 03:37 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:A MARA OASISFACILITY NUMBER:
197610539
ADMINISTRATOR:SZALONEK, FEFACILITY TYPE:
740
ADDRESS:15114 ROXFORD STREETTELEPHONE:
(747) 246-3242
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 6CENSUS: 0DATE:
03/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Akhilesh Jha - Licensee RepresentativeTIME COMPLETED:
12:09 PM
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Licensing Program Analyst (LPA) Gary Tan conducted an announced Pre Licensing visit to this facility and met with Licensee representative Akhilesh Jha. The applicant is "Oasis Manors Inc.,". Fire Clearance dated 01/29/24 was received for six (6) non-ambulatory residents, all (6) of which maybe bedridden.

Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6.

Facility is a single storey home. Today's site visit consisted of LPAs touring the physical plant at 9:21 AM inside and outside and observed the following:

The facility smoke alarm system is hard wired and interconnected. The fire extinguisher is located near the dining area and was observed to be fully charged and last bought on 11/02/23. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested and observed to be operational. The facility is equipped with sprinkler system. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted on the hallway wall with other posting requirements. There are six (6) resident bedrooms, all private with own bathroom on each room. There is one (1) additional bathroom for common use. Resident bedrooms were observed to be appropriately furnished. The common areas (living room, kitchen and dining areas) were appropriately furnished and lighting was adequate. The living room has a comfortable furniture. Residents and staff records will be stored in a secured filing cabinet in the office in another building within the compound. Medications will be stored in the cabinet along the bedroom hallway observed with a locking mechanism. The first aid kit is readily available in the drawer in the screening area. The bathrooms have appropriate grab bars installed and non-skid mats. Hot water was tested in the residents' bathroom and measured between 112.3°F to 114.2°F. (continued to LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A MARA OASIS
FACILITY NUMBER: 197610539
VISIT DATE: 03/20/2024
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(continued from LIC 809)

The kitchen knives and sharps will be stored in a locked drawer in the kitchen. Kitchen cleaning supplies are stored in a locked cabinet in the bedroom hallway. Laundry detergents, cleaning supplies and other toxins are stored in a locked cabinet in the bedroom hallway cabinet. The laundry area is located along the bedroom hallway. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors and locked areas for centrally stored medications. Auditory alarms were tested and observed to be operational. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional.

There will be a screening station immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks will be available. Required poster are posted all over the facility. The facility had submitted a Mitigation and Infection plan.

There is a sitting area in the front, side and backyards for residents to conduct outdoor activities. The backyard is fenced. The swimming pool is appropriately fenced and observed to be locked. There is a Infra-red Sauna beside the swimming pool. There is a storage area near the front gate for PPE and other supplies. There is no garage at the facility only car ports on the front yard.

Component III was conducted with the licensee representative and his house manager, Aurora Solis.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.

Exit interview conducted and copy of this report issued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC809 (FAS) - (06/04)
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