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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604326
Report Date: 07/18/2024
Date Signed: 07/18/2024 11:37:22 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2023 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20231207114342
FACILITY NAME:OASIS VILLAGE CAREFACILITY NUMBER:
374604326
ADMINISTRATOR:SAHID, RAMLAFACILITY TYPE:
740
ADDRESS:3865 SHIRLENE PLTELEPHONE:
(619) 727-7335
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:6CENSUS: 4DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Ramla Sahid, AdministratorTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Staff do not ensure there is an adequate supply of food in the facility
Staff do not provide adequate food service to residents
Staff do not administer resident's medications as prescribed
Staff do not ensure record of centrally stored medications was accurate and complete

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by the Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Administrator.

On October 31, 2023, an allegation was made that Staff do not provide adequate food service to residents; Staff do not ensure there is a sufficient supply of food in the facility; Staff does not administer resident's medications as prescribed; Staff do not ensure the record of centrally stored medications was accurate and complete which raised concerns about potential neglect. The investigation included interviews with staff members, the resident, the Power of Attorney, a review of records, and a tour of the facility.

{Continued on 9099 C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20231207114342
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OASIS VILLAGE CARE
FACILITY NUMBER: 374604326
VISIT DATE: 07/18/2024
NARRATIVE
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The complainant was interviewed to obtain their account of the events. The complainant stated that the resident was on hospice and did not know what type of diet the resident was on at the time of reporting the complaint.

During the interview with the resident, confirmed that they had received their meals regularly and did not experience any instances of not being fed by the staff. All staff members denied the alleged allegation and provided consistent statements that the residents were served meals as per their dietary requirements. Relevant documentation for medication administration records (MAR), including resident care records, meal schedules, and incident reports, were reviewed to identify any discrepancies or patterns. No discrepancies were found. The Power of Attorney (POA) for the resident has not had any issues with the facility, and the resident's meals are balanced and nutritious, the medications are being administered as prescribed.

Based on the review of documentation, the allegations of Staff do not provide adequate food service to residents; Staff does not ensure there is an adequate supply of food in the facility; Staff does not administer resident's medications as prescribed; Staff does not ensure a record of centrally stored medications was accurate and complete are Unsubstantiated due to a lack of conclusive evidence. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the and his signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
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