A Siwa Oasis

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility today. LPA met with House Manager Ver Carlo San Juan and explained the purpose of this visit. A tour of the physical plant was conducted at 12:25 PM and the following was observed: The facility is within a compound and has only one main gate entrance. There is only one main door of the facility being used. The screening station is located immediately upon entrance. The facility has an approved mitigation and infection plan on file. The facility is a single storey building with three (3) other Residential Care Facility for the Elderly (RCFE) facilities inside the compound. There are five (5) resident bedrooms, four (4) private, one (1) with own bathroom and one (1) shared room. There are three (3) total bathrooms. Resident bedrooms were observed to be appropriately furnished. The facility is fire cleared for six (6) non-ambulatory residents, all of which maybe bedridden. Hospice waiver for six (6) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 74°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected, tested and observed to be operational. There is a Fire extinguisher located in the kitchen last bought on 03/25/26. The facility is equipped with sprinkler system. (continued on LIC 809-C) (continued from LIC 809) Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry area is located in the staff room in another building. Laundry detergent, cleaning solutions and other toxins are observed to be locked in the storage area by the gate. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at a range of 109.4°F to 111.6°F Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet. Medications: LPA observed that the medication is kept in the other building (A Siwa) and was observed to be locked and inaccessible to residents. There was a complete first aid kit located in the office within the facility. Garage: There is no garage at the facility only car ports at the front area. The Backyard had a covered shaded area for clients with outdoor furniture. Sauna, and mini golf course. The swimming pool is appropriately fenced and was observed to be locked during visit. Client records. All five (5) residents' record were reviewed and observed to be complete and current. Staff records were also reviewed and observed to be complete and current. Disaster drill was last conducted on 04/27/26. Required posting observed in facility (complaint hot line poster, personal rights, etc). Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, May 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced One (1) year Required visit at this facility. LPA met with Administrator Patria Dufrenne and explained the purpose of this visit. A tour of the physical plant was conducted at 12:26 PM and the following was observed: The facility is within a compound and has only one main gate entrance. There is only one main door of the facility being used. The screening station is located immediately upon entrance. The facility has an approved mitigation and infection plan on file. The facility is a duplex type single storey building with three (3) other Residential Care Facility for the Elderly (RCFE) facilities inside the compound. There are five (5) resident bedrooms which are private with one bathroom for each room and one (1) shared bedroom. Resident bedrooms were observed to be appropriately furnished. The facility is fire cleared for six (6) non-ambulatory residents, all of which maybe bedridden. Hospice waiver for six (6) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 74°F. The dual smoke/carbon monoxide alarm are hardwired and interconnected, tested and observed to be operational. There is a Fire extinguisher located in the kitchen last bought on 03/26/25. The facility is equipped with sprinkler system. (continued on LIC 809-C) (continued from LIC 809) Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry area is located in the staff room in another building. Laundry detergent, cleaning solutions and other toxins are observed to be locked in the storage area by the gate. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at a range of 111.4°F to 115.2°F Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet. Medications: LPA observed that the medication is kept in the other building (A Siwa) and was observed to be locked and inaccessible to residents. There was a complete first aid kit located in the office within the facility. Garage: There is no garage at the facility only car ports at the front area. The Backyard had a covered shaded area for clients with outdoor furniture. Sauna, and mini golf course. The swimming pool is appropriately fenced and was observed to be locked during visit. Client records. All six (6) residents record were reviewed and observed to be complete and current. Staff records were also reviewed and observed to be complete and current. Disaster drill was last conducted on 01/10/25. Required posting observed in facility (complaint hot line poster, personal rights, etc). Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Case Management - Deficiencies

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-20241127154156.. 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) Trash, recycling and other waste materials were obstructing the gate 2) No certified administrator for this facility. Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 10, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(6) · Plan of correction due date: Dec 3, 2024

Personal Accommodations and Services: The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on LPM and LPA obsevation, Licensee did not ensure that the gate is free of obstruction which poses a potential health and safety and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Dec 10, 2024

Plan of correction: The designee agreed to clean up the trash and submit a photo of completion on or before the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Dec 17, 2024

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: 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.the state’s words, verbatim · CDSS document, Dec 10, 2024

Plan of correction: 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.

Allegation investigated: Staff are utilizing combination locks on the exits from the property to keep residents in

Licensing Program Analyst (LPA) Gary Tan and Licensing Program Manager (LPM) Troy Agard conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA initially met with staff Flordeliz Chico who called the administrator Patria Dufrenne who arrived two (2) hours later. LPA and LPM conducted physical plant tour at 9:30 AM, requested copies of facility documents at 9:45 and interviewed staff and residents between 9:45 AM to 10:15 AM. It was alleged that the main gate going to and from the facility was locked. LPA and LPM observed during physical plant tour that there were two (2) main gates for the entire compound, supposedly one for ingress and one for egress, the ingress gate however is currently not being utilized leaving one gate for car and pedestrian to use. It was observed that it was locked with a combination pad lock and LPA and LPM's interview with Staff #1 (S1) revealed that they were locking the gate due to a resident of another facility within the compound always getting out to buy alcohol. Based on the information gathered during this visit, the allegation is deemed substantiated at this time. Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued. Substantiatedthe state’s words, verbatim · CDSS document, Dec 5, 2024 · control 31-AS-20241127154156

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468(1)(a)(6) · Plan of correction due date: Dec 6, 2024

(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department This requirement is not met as evidenced by: Based on observation, licensee failed to ensure that the residents are not locked in the premises which poses an immediate health & safety and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Dec 5, 2024

Plan of correction: The designee agreed to remove tha pad lock during the day and put a sensor to ensure that the staff are alerted when a resident is leaving the facility at anytime.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced case management visit at this facility to cite the deficiency discovered while investigating complaint control no.:31-AS-20241127154156. During LPA's record review, LPA discovered that Staff #1 (S1) is not associated at this facility during this visit. Citation issued. Civil penalty assessed. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 5, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(c)(1) · Plan of correction due date: Dec 6, 2024

A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department: (1) A signed Criminal Background Clearance Transfer Request, LIC 9182 This requirement is not met as evidenced by: Based on record review, licensee did not ensure that S1 is associated at this facility which poses an immediate health, safety and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Dec 5, 2024

Plan of correction: Administrator will send proof of association or will send an association documents for S1 to CCL on or before the POC date, if unable to log in at Guardian.

Type of visit: Prelicensing

Licensing Program Analyst (LPAs) Ray Comer and Gary Tan conducted an announced Pre-Licensing visit to this facility and met with Licensee representative Akhilesh Jha. The applicant is "Oasis Manors Inc.,". Fire Clearance dated 01/24/24 was received for six (6) non-ambulatory residents, all (6) of which maybe bedridden. Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. Facility is a single-story home. Today's site visit consisted of LPAs touring the physical plant at 9:50 AM inside and outside and observed the following: The facility smoke alarm system is hard wired and interconnected. Fire extinguishers are located on wall of near the dining area and another fire extinguisher located in the common living area; both extinguishers are observed to be fully charged and purchased on 11/02/23. The facility maintains dual Carbon Monoxide/Smoke alarm detectors installed throughout the common areas of the facility. Alarms were tested and observed to be operational. The facility is equipped with sprinkler system. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted on the hallway wall with other posting requirements. There are five (5) resident bedrooms which are private with one bathroom for each room, and one (1) shared bedroom. Resident bedrooms were observed to be appropriately furnished. The common areas (living room, kitchen and dining areas) were appropriately furnished, and lighting was adequate. The living room is furnished with comfortable furniture. Residents and staff records will be stored in a secured filing cabinet in the office in another building within the compound. Medications will be stored in the cabinet along the bedroom hallway observed with a locking mechanism. The first aid kit is readily available in the drawer in the screening area. The bathrooms have appropriate grab bars installed and non-skid mats. Hot water was tested in residents’ bathrooms and measured at 107.2°F. (Continued from LIC 809) The kitchen knives and sharps will be stored in a locked drawer in the kitchen. Kitchen cleaning supplies are stored in a locked in the cabinet below the sink. Laundry detergents, cleaning supplies and other toxins are stored in a locked cabinet in the laundry area. The laundry area is in a closeted space in the hallway area of the facility. Facility maintains the necessary precautions to safely house dementia residents such as auditory alarms on all doors and locked areas for centrally stored medications. Auditory alarms were tested and observed to be operational. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional. A visitor sign-in sheet and screening station were present at the facility entrance. Sign in sheet, hand sanitizer, gloves and masks were observed. Required poster are posted all over the facility. The facility has submitted a Mitigation and Infection plan. There is a sitting area in the front, side and backyards for residents to conduct outdoor activities. The backyard is fenced. The backyard area has a swimming pool which is appropriately fenced and observed to be locked. There is a Infra-red Sauna beside the swimming pool. There is a storage area near the front gate for PPE and other supplies. The front of the facility maintains an open car port parking space. Facility does not have a garage. Component III was conducted with the licensee representative and his house manager, Aurora Solis. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Mar 22, 2024