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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002926
Report Date: 01/27/2025
Date Signed: 01/28/2025 03:57:00 PM

Document Has Been Signed on 01/28/2025 03:57 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
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: 3DATE:
01/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:44 AM
MET WITH:Cristo Forero, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:39 PM
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Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPAs were greeted and granted entry by Tricia Forero after explaining the purpose of the visit. Administrator (AD) Cristo Forero was present at the facility and assisted with the inspection. LPA observed the Administrator Certificate expired September 27,2024, however LPA verified there was an active certificate with an effective date of September 26,2024. AD to post certificate once received. This is a Residential Care Facility for the Elderly (RCFE) licensed to four non-ambulatory residents, with a hospice waiver for two. The facility is a two story home with six bedrooms, three bathrooms, and an attached garage. Two bedrooms and one bathroom are located on the first floor of the facility and used for residents only. The second floor of the home is used for the staff.

During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following:

LPA observed residents watching television in the living room and resting in their respective bedrooms. LPA observed three residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the entryway. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway cabinets. LPA observed bathroom was clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathroom was observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 115.5 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction and hazards. LPA observed the backyard had a shaded sitting area with furniture for resident use.

Continued on 809-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: OASIS HOME FOR THE ELDERLY II
FACILITY NUMBER: 306002926
VISIT DATE: 01/27/2025
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LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke and carbon monoxide detectors tested operational. Two fire extinguishers were observed to be fully charged and located in the kitchen and garage. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. The garage is used for storage and is kept locked and inaccessible to residents. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents under the kitchen sink. LPA observed knives were stored and locked above the fridge. LPA observed the First Aid Kit had all the required components. LPA observed the facility conducted their last emergency disaster drill on January 4, 2025 and are conducted every 3 months.

During medication review, medication was observed to be centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care.

LPA reviewed three resident's records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed two employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate.



Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
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