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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200513
Report Date: 08/06/2026
Date Signed: 08/06/2026 02:25:41 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/06/2026 02:25 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:OAKLAND HEIGHTS SENIOR LIVINGFACILITY NUMBER:
019200513
ADMINISTRATOR/
DIRECTOR:		GARCIA, ANTHONYFACILITY TYPE:
740
ADDRESS:2330, 2350, 2361 E 29TH STTELEPHONE:
(510) 534-3637
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 197CENSUS: 105DATE:
08/06/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Executive Director, Anthony GarciaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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[-On 8/6/2026 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct an Annual continuation inspection for initial annual conducted 7/10/2026. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. The facility’s fire clearance was approved for 166 non-ambulatory, 10 may be bedridden, Hospice waiver for 10.

LPA toured the facility with Executive Director, Anthony Garcia including but not limited to random residents apartments, bathrooms, multiple common areas, and courtyards. LPA reviewed 5 residents records. LPA reviewed 5 staff records and 4 of 5 have current first aid training and 5 out of 5 associated to the facility.

Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 9/01/2026:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 500 Personnel Report
LIC 610E Emergency Disaster Plan
Liability Insurance
Current Administrator’s Certificate

Report continues on LIC809-C
Yvonne Flores-Larios
Alona Gomez
DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2026
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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513
VISIT DATE: 08/06/2026
NARRATIVE
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THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT 7/10/2026:
  • At 9:42am LPA observed the main living room floor/carpet covered with debris, trash, and crumbs. at 11:12am LPA observed it had still not been cleaned (throughout visit LPA observed floors, surfaces, unsanitary ie hallway floors with spills and sticky, in dining spills that have turned sticky, in kitchen/dining splatters of unknown substances on floor and wall, doors with dirt, crumbs of food throughout facility) at 10:50 observed thick cobwebs and dust on windows
  • At 9:44am LPA observed unlocked knives in Bistro area. At 10:48am LPA observed unlocked cleaning supply of spic and span in resident dining
  • At 10:33am LPA observed improper food storage in kitchen (ie fresh cilantro left out at room temperature (warm to touch), refrigerate after opening foods left at room temperature, left open peanut butter, in refrigerator improperly sealed dressing, sour cream, in dry pantry improperly sealed sugar, and tortillas
  • At 10:49AM LPA observed live roach in resident dining/kitchen area
  • At 10:52AM LPA observed unlocked resident files in common hallway (downstairs, main building 2361)
  • LPA observed in R9's room improper bedding where the sheet or covering was ripped exposing mattress and blanket. LPA observed in R10's room improper bedding where there was only an unclean flat sheet with brown drips that appeared to be feces and a single blanket
  • LPA observed in R7's room unsecured medications a review of residents physicians report dated 7/7/23 states that resident is unable to manage medications and PRNs, and is unable to store medications. medications observed include but are not limited to Tylenol, Donepezil 5mg, melatonin, Tussin cough, and others. LPA observed in R8's room PRNs a review of residents 602 dated 7/7/23 states that resident is unable to manage medications and PRNs, and is unable to store medications. medications observed include but are not limited to Tylenol and Musinex.


Report continues on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Yvonne Flores-Larios
NAME OF LICENSING PROGRAM ANALYST: Alona Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2026 02:25 PM - It Cannot Be Edited


Created By: Alona Gomez On 08/06/2026 at 10:39 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2026
Section Cited
CCR
87309(a)

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(a)Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement was not met as evidence by:
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By POC facility agrees to conduct a formal training to all care staff and house keepers in relation to storage space and access and provide training materials to CCLD.

$250 Civil Penalty Issued For Repeat Violation in 12month Period.
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Based on observations, the licensee did not comply with the section cited above by having unlocked sharps and chemicals in resident common areas which posed an immediate safety risk to persons in care.
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Type A
08/27/2026
Section Cited
CCR87465(h)(2)

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(h)The following requirements shall apply to medications which are centrally stored:(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement was not met as evidence by:
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By POC facility agrees to conduct a formal training to all care staff in relation to medication management and assistance and provide training materials to CCLD.
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Based on observations and record review, the licensee did not comply with the section cited above by having medications that are required to be centrally stored accessible to residents R7, and R8 which posed an immediate safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513
VISIT DATE: 08/06/2026
NARRATIVE
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THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT 8/6/2026:
  • During file review LPA observed Employee file incomplete S2 (missing job application, health screening, TB test)
  • During file review LPA observed Staff not up to date on required annual training's S2-S5 (S4 missing First Aid, S2-S5 missing full required annual training's all previous training's are prior to 2025)


*Civil Penalties assessed $250 for repeat violations in a 12 month period*

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Yvonne Flores-Larios
NAME OF LICENSING PROGRAM ANALYST: Alona Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2026 02:25 PM - It Cannot Be Edited


Created By: Alona Gomez On 08/06/2026 at 01:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2026
Section Cited
CCR
87412(a)

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(a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement was not met as evidence by:
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By POC facility agrees to audit all staff files and ensure completion then notify CCLD.
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Based on record review the licensee did not comply with the section cited above by S2's file being incomplete in missing their job application/start date, health screening, and TB test results) which poses a potential personal rights risk to persons in care.
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Type B
09/03/2026
Section Cited
CCR87411(c)

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(c)All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69

This requirement was not met as evidence by:
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By POC facility agrees to audit all staff files and ensure completion od all required training's for care staff by a CCLD approved vendor and notify CCLD.
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Based on record review the licensee did not comply with the section cited above by S2-S5 not having required annual training's which poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
Page: 9 of 9
Document Has Been Signed on 08/06/2026 02:25 PM - It Cannot Be Edited


Created By: Alona Gomez On 08/06/2026 at 11:43 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2026
Section Cited
CCR
87307(3)(C)

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(3)Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C)Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited.

This requirement was not met as evidence by:
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By POC facility agrees to dispose of all ripped linens, ensure all residents linens are clean, ensure all residents have readily accessible all required linens, and notify CCLD to reinspect.
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Based on observations the licensee did not comply with the section cited above by R9 and R10 having inadequate linens for their respective beds which poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2026 02:25 PM - It Cannot Be Edited


Created By: Alona Gomez On 08/06/2026 at 11:24 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2026
Section Cited
CCR
87303(a)

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(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement was not met as evidence by:
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By POC facility agrees to develop and implement daily checks and cleanings of common areas and notify CCLD to reinspect
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Based on observation, the licensee did not comply with the section cited above by facility being unclean and unsanitary throughout (the main living room floor/carpet covered with debris, trash, and crumbs, floors, surfaces, unsanitary ie hallway floors with spills and sticky, in dining spills that have turned sticky, in kitchen/dining splatters of unknown substances on floor and wall, doors with dirt, crumbs of food throughout facility) which poses a potential personal rights risk to persons in care.
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Type B
09/03/2026
Section Cited
CCR87555(a)

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(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.

This requirement was not met as evidence by:
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By POC facility agrees to conduct a formal training with all kitchen staff regarding proper food preparation and storage and provide training materials used to CCLD as well as notify CCLD to reinspect
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Based on observation, the licensee did not comply with the section cited above by facility being unclean and unsanitary throughout (the main living room floor/carpet covered with debris, trash, and crumbs, floors, surfaces, unsanitary ie hallway floors with spills and sticky, in dining spills that have turned sticky, in kitchen/dining splatters of unknown substances on floor and wall, doors with dirt, crumbs of food throughout facility) kitchen staff not ensuring proper food storage which poses a potential health and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2026 02:25 PM - It Cannot Be Edited


Created By: Alona Gomez On 08/06/2026 at 11:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEIGHTS SENIOR LIVING
FACILITY NUMBER: 019200513

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2026
Section Cited
CCR
87555(b)(27)

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(b)The following food service requirements shall apply: (27)All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.

This requirement was not met as evidence by:
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By POC facility agrees to have pest control come and treat facility perimeters as well as kitchen area and submit proof of service to CCLD
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Based on observations the licensee did not comply with the section cited above by an alive roach being in the cabinet located in the resident dining kitchen area which poses a potential personal rights risk to persons in care.
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Type B
08/27/2026
Section Cited
CCR87506(c)(1)

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(c)All information and records obtained from or regarding residents shall be confidential.(1)The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.

This requirement was not met as evidence by:
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By POC facility agrees to ensure all files of residents current and past are in a secure location to ensure confidentiality and provide CCLD with the new location/ area of storage.
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Based on observations the licensee did not comply with the section cited above by having resident files accessible and unlocked exposing confidential information in common hallway in the downstairs, main building which poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2026


LIC809 (FAS) - (06/04)
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