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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002926
Report Date: 05/03/2024
Date Signed: 05/03/2024 11:32:01 AM

Document Has Been Signed on 05/03/2024 11:32 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:OASIS HOME FOR THE ELDERLY IIFACILITY NUMBER:
306002926
ADMINISTRATOR/
DIRECTOR:
OLGA MORENO/CRISTO FOREROFACILITY TYPE:
740
ADDRESS:25306 PACIFICA AVENUETELEPHONE:
(949) 454-9188
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 4CENSUS: 2DATE:
05/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:21 AM
MET WITH:Olga Moreno, Administrator
Cristo Forero, Administrator
TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On this day, Licensing Program Analysts (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility administrator Olga Moreno after introducing himself and stating the purpose of the visit.

During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a two-story home with two shared resident bedrooms and one shared bedroom in addition to the common living areas. Staff quarters are located on the second floor. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets and an adequate additional supply is present. The backyard has a shaded area and the route of egress is free of clutter and obstructions. There are currently two residents in care at the facility, none of which are receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Combined smoke and carbon monoxide detectors tested operational. Fire extinguisher present is observed to be fully charged with up-to-date maintenance. Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed two resident files and two staff files. The two staff members on duty were interviewed along with the two residents.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Two Technical Violation Advisory Notes were also provided to the licensee. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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