Georgian Oasis

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The acting Administrator, Angelica Penales and Licensee Representative, Zharmaine Ollesca, arrived shortly after and the reason for the visit was explained. Entrance interview. The facility is single story house with an attached garage located in a residential neighborhood. The LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. INTERVIEWS: Starting at 10:05 a.m. and throughout the visit one (1) staff and one (1) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. COMMON AREAS: This includes the living room, open office area, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 2:40p.m., hardwire combination of smoke, carbon monoxide detectors and a fire door were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 08/19/2026. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. Activities were observed in the common areas. The electric fireplace in the living room is non-functional, and there are no tools. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are five (5) total bedrooms in the facility; four (4) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a shared, double occupancy resident bedroom. There is no staff room and Administrator stated that staff remain awake at night. Four (4) out of five (5) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA observed two (2) closets / storage space in the main hallway one (1) locked containing personal protection equipment (PPE) , incontinent supplies and hygiene supplies and one (1) hidden with the bamboo wall panel containing extra clean linens and towels for resident use. RESTROOMS: There are two (2) total restrooms. One (1) is designated as a shared / common resident restroom, One (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 110.4 - 111.3 degrees Fahrenheit, all within the required range. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.1 degrees Fahrenheit. Cleaning supplies and other chemicals are kept in a locked cabinet under the sink area and in the laundry room locked and inaccessible to residents in care. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to bedroom #4 in the main hallway. Laundry room has a washer and dryer and locked cleaning supplies. BACKYARD: The entire property is fenced. There are two (2) covered patio areas with tables and chairs for resident use. The back and sides of the house are separated from the front yard by gates at the north and south side passageways. There are no other structures on the property. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Two (2) outdoor exit gates were observed to be self-closing and self-latching at the time of the visit. All passageways were observed to be clear and free of obstructions at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... GARAGE: LPA observed the attached facility garage, accessible through the kitchen which was locked at the time of the visit. LPA observed facility supplies such as an extra mattress, hardware supplies, a staff refrigerator, emergency food and water. LPA also observed a staff lounge area with chairs and storage space. RECORDS: Resident Records Four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Pre- admission appraisal, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records Five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. At the time of the visit LPA conducted a business search to ensure the Business / LLC is in good standing ; LLC is Active and in good standing. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The emergency disaster was updated on 08/13/26 and the infection control plan was reviewed on 08/13/26. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. The last emergency disaster drill took place on 07/18/26 and are conducted quarterly. MEDICATIONS: Medication review began at approximately 1:40 p.m. Medications are centrally stored and locked in a cabinet in the dining room adjacent to the living room. Medications for two (2) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were properly documented on the centrally stored medications and destruction record, stored, locked and inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. No errors observed during review. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, copy of the Limited Liability insurance and LIC 610E copy of the emergency disaster plan . At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator updated phone numbers and emailed and confirmed that all information is accurate. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Aug 19, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a post licensing visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by staff / Designee who called the Administrator to inform them of the visit. The Administrator, Armyla Epstein was in a meeting and unable to physically attend however was available telephonically throughout the visit. The Administrator stated that Designee / Manager on duty, Marky Pascua would sign the report. The reason for the visit was explained. Entrance interview. The facility is single story house with an attached garage. An approved fire clearance was received, clearing them for 5 non-ambulatory residents in rooms 1, 2,3,4 and 1 bedridden resident in room 5 with a total capacity of six (6). A dementia program was included in the plan of operation. A Hospice Waiver has been granted for six (6) residents. The LPA and Designee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes the living room, open office area, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 12:01 p.m., hardwire combination of smoke, carbon monoxide detectors and a fire door were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 04/02/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 11/19/2025 and will be conducted quarterly. Activities were observed in the common areas. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... The electric fireplace in the living room is non-functional, It is screened and there are no tools. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. BEDROOMS: There are five (5) total bedrooms in the facility; four (4) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a shared, double occupancy resident bedroom. There is no staff room and Designee stated that staff remain awake at night. Four (4) out of five (5) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA observed two (2) closets / storage space in the main hallway one (1) locked containing personal protection equipment (PPE) , incontinent supplies and hygiene supplies and one (1) hidden with the bamboo wall panel containing extra clean linens and towels for resident use. RESTROOMS: There are two (2) total restrooms. One (1) is designated as a shared / common resident restroom, One (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 107.4 - 108.3 degrees Fahrenheit, all within the required range. KITCHEN: The LPA inspected the kitchen/food service area at 10:33 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 108.3 degrees Fahrenheit at 10:35 a.m. Cleaning supplies and other chemicals are kept in a locked cabinet under the sink area and in the laundry room locked and inaccessible to residents in care. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to bedroom #4 in the main hallway. Laundry room has a washer and dryer and locked cleaning supplies. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... BACKYARD: The entire property is fenced. There are two (2) covered patio areas with tables and chairs for resident use. The back and sides of the house are separated from the front yard by gates at the north and south side passageways. There are no other structures on the property. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Two (2) outdoor exit gates were observed to be self-closing and self-latching at the time of the visit. All passageways were observed to be clear and free of obstructions at the time of the visit. GARAGE: LPA observed the attached facility garage, accessible through the kitchen which was locked at the time of the visit. LPA observed facility supplies such as an extra mattress, hardware supplies, a staff refrigerator, emergency food and water. LPA also observed a staff lounge area with chairs and storage space. RECORDS: Record review began at approx. 10:40 a.m. Resident Records: were reviewed beginning at 10:46 a.m. Three (3) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records: were reviewed beginning at 11:40 a.m. five (5) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. Report Continued on LIC 809-C PAGE 4... (PAGE 4) Report Continued from LIC 809-C PAGE 3... MEDICATIONS: Medication review began at approximately 12:11 p.m. Medications are centrally stored and locked in a cabinet in the staff dining room / open office area adjacent to the kitchen. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. LPA observed the first aid supplies to be complete, including a thermometer and a current version of a first aid manual located in the laundry room. INTERVIEWS: Starting at 1:25 p.m. and throughout the visit one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff is knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the current Limited Liability insurance. LPA provide the facility with the updated Component III - RCFE Supplemental Handout. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report reviewed and provided.the state’s words, verbatim · CDSS document, Nov 19, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Mosley conducted a pre-licensing visit to the above noted facility. The LPA met with applicant Armyla Epstein, along with Rowena Marantal Carrillo and Angelica Penales. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been granted for six (6) residents. The facility is single story house. At 10:28 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for 5 non-ambulatory residents in rooms 1, 2,3,4 and 1 bedridden resident in room 5. The facility has 4 private resident bedrooms, Rooms # 2,3,4, and 5 and 1 shared room, Room # 1. Rooms 2,3,4 and 5 have direct exits to the outside. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs, and closet space. The beds are furnished with box springs, comfortable mattress, and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. There are 2 bathrooms, both designated as resident bathrooms. The resident bathroom(s) has a shower with slip resistant surface / material / mat. The toilet and shower have grab bars. Bedroom 1 has a private bathroom. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... Resident and staff records will be stored in a locked cabinet space which is currently located in the living room area / open office area. Medications are centrally stored in a locked closet in the main hallway adjacent to room #1. There is a mini refrigerator for medications that require refrigeration. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a the kitchen area and another one located in the laundry room in the disaster kit. Kitchen knives are stored in a locked cabinet in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the laundry area and kitchen area. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to non-private bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is an electric fireplace in the living room. It is screened and there are no tools. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2...The facility smoke alarm system is hard wired. The smoke detector, fire doors, and carbon monoxide detectors were tested and functioned properly during the time of visit. There are two (2) fire extinguishers throughout the house and two (2) in the garage, with a total of four (4) They are fully charged and do not exceed the expiration date. Hot water was tested in each bathroom, which included the resident bathroom(s) and any common bathrooms, in addition to the kitchen; and, the hot water ranged from 105 to 120 degrees Fahrenheit. The laundry room is accessible through the bedroom hallway. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the locked laundry room. Extra incontinence supplies are stored in laundry room. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted at the entry way. The emergency telephone numbers are posted in the entry way. Other required postings are posted at the entry way. The exterior passageways were clean and clear of any obstructions. There are two (2) covered patio areas at the back of the house with tables and chairs where residents can sit. The entire property is fenced. The back and sides of the house are separated from the front yard by gates at the north and south side passageways. There are no other structures on the property. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Two (2) outdoor exit gates were observed to be self-closing and self-latching at the time of the visit. The garage is accessible from the house adjacent to the kitchen and will be used as storage and staff lounge; the doors were locked and will remain locked and inaccessible to residents in care. No citations issued on a pre-licensing visit. During today’s visit COMP III orientation was completed with facility Administrator and Licensee Representative, Armyla Epstein, Rowena Marantal Carrillo and Angelica Penales. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Aug 27, 2025