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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800430
Report Date: 01/17/2025
Date Signed: 01/17/2025 12:47:20 PM

Document Has Been Signed on 01/17/2025 12:47 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:OASIS OF LOVE PLAZA CAREFACILITY NUMBER:
197800430
ADMINISTRATOR/
DIRECTOR:		LAURA IGNACIOFACILITY TYPE:
740
ADDRESS:2993 BAYBERRY COURTTELEPHONE:
(909) 217-7866
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY: 6CENSUS: 4DATE:
01/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:02 PM
MET WITH:Monina Barinca, CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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A Case Management visit was conducted during the course of the investigation of complaint #28-AS-20250107094321 by Licensing Program Analysts (LPAs), Mayra Cota, Nune Margaryan and Luis De Leon. The following deficiency was observed:

At the time of visit, LPAs tested the water temperature in both bathrooms and observed that initial water temperature was 129 degrees F and 137.3 degrees F.


The deficiency cited is documented on the LIC 809D.

Exit interview held with Monina Barican and Appeals Rights were provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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 01/17/2025 12:47 PM - It Cannot Be Edited


Created By: Mayra Cota On 01/17/2025 at 12:09 PM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: OASIS OF LOVE PLAZA CARE
FACILITY NUMBER: 197800430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2025
Section Cited
CCR
87303(e)(2)

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Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows:
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
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Water temperature was adjusted at the time of visit and licensee will esnure water temperature stays within range by checking it daily. Licensee will submit logged sheet with adjusted water temperature for one week to LPA, Mayra Cota.
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Based on obseervation the licensee did not comply with the sections cited above Water temperature was tested in bathrooms 129 degrees F and 137.3 degrees F. which poses an immediate health, safety or personal rights risk to persons 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:Wei Siew Ho
LICENSING EVALUATOR NAME:Mayra Cota
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2025


LIC809 (FAS) - (06/04)
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