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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610539
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:15:21 PM

Document Has Been Signed on 12/10/2024 01:15 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/
DIRECTOR:		SZALONEK, FEFACILITY TYPE:
740
ADDRESS:15114 ROXFORD STREETTELEPHONE:
(747) 246-3242
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 6CENSUS: 3DATE:
12/10/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Flordeliz Chico - StaffTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced case management visit at this facility in conjunction with a complaint investigation control no.: 31-AS-20241127155153. LPA met with staff Flordeliz Chico who called the Designee Patria Dufrenne and the reason for the visit was explained. Ms. Dufrenne designated Ms. Chico to sign the report.

On 12/05/24 at around 9:30 AM. LPA & Licensing Program Manager (LPM) Troy Agard conducted a physical plant tour of the four (4) facilities on the property from 9:30 AM to 10:15 AM. The following health and safety violations were observed at this facility:

1) Toxins were observed accessible to residents in care.

2) No certified administrator for this facility.

Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/10/2024 01:15 PM - It Cannot Be Edited


Created By: Jose Gary Tan On 12/10/2024 at 11:53 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
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A MARA OASIS
FACILITY NUMBER: 197610539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2024
Section Cited
CCR
87309(a)

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Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
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The staff removed the toxins and kept in a locked cabinet. LPA also did not observe any toxins during visit. Cleared during visit.
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Based on LPA and LPM's observation, Licensee did not ensure that all toxins are inaccessible to residents, this poses an immediate health and safety risks to the residents in care.
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Type B
12/17/2024
Section Cited
CCR87405(a)

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Administrator - Qualifications and Duties: All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person…

This requirement is not met as evidenced by:
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The designee agreed to appoint an administrator for this facility and submit the change of administrator request to CCL on or before the POC date.
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Based on record review, the licesee did not ensure that the facility has an Administrator as the Administrator on record is no longer working at this facility. This poses a potential health and safety risk to the residents 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:Troy Agard
LICENSING EVALUATOR NAME:Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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