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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200513
Report Date: 08/12/2026
Date Signed: 08/12/2026 03:03:43 PM

Document Has Been Signed on 08/12/2026 03:03 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:
08/12/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Anthony Garcia, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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On 08/12/2026 at 11:00 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct a case management visit regarding an incident that was reported to CCLD involving residents R1 and R2. The reporting party stated in a video on social media that showed R1 and R2 walking on the shoulder of the freeway on 07/25/2026 after leaving the facility unassisted.

The video footage of the incident was observed by LPA. S1 also reviewed the footage.

According to an email from the front desk to the Executive Director, which was reviewed by LPA, on 07/25/2026, R1 and R2 left the facility and were reportedly headed to a store when they became lost. R1 and R2 were both observed traveling along the shoulder of the freeway. R1 and R2 returned to the facility without reported injuries.

During the visit, LPA conducted an interview with S1. S1 stated that R1 and R2 are residents of the facility's assisted living. S1 stated that R1 and R2 are permitted to leave the facility unassisted. LPA reviewed R1 and R2's files and obtained a copy of R1 and R2's Assessment, Physician's Reports, and a copy of the visitor's log for 07/25/2026. R1 and R2's names were not listed on the visitor log dated 07/25/2026.

***CONTINUE ON 809C***

Yvonne Flores-Larios
Ardalan Gharachorloo
DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2026
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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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: 08/12/2026
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***CONTINUE FROM 809***

The following deficiencies were observed:

LPA reviewed R1 and R2's Resident Assessments and Physician's Reports. R1's Resident Assessment is dated 12/05/2025, and the Physician's Report is dated 03/05/2024. R2's Resident Assessment is dated 05/25/2026, and the Physician's Report is dated 02/10/2020. Based on the records reviewed, the facility has not updated R1 and R2's Resident Assessments and Physician's Reports since the incident occurred.

Additionally, the facility did not submit an incident report to CCLD regarding the incident that occurred on 07/25/2026.

The above deficiencies were observed (see LIC 809-D) and cited in accordance with the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in additional civil penalties.

An exit interview was conducted, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Yvonne Flores-Larios
NAME OF LICENSING PROGRAM ANALYST: Ardalan Gharachorloo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/12/2026 03:03 PM - It Cannot Be Edited


Created By: Ardalan Gharachorloo On 08/12/2026 at 12:55 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: 08/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2026
Section Cited
CCR
87463(a)

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(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.
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Licensee shall complete updated reappraisals for R1 and R2 and submit copies to CCLD by the POC due date.
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Based on records review and interview, R1 and R2 left the facility unassisted on 07/25/2026, became lost, and were observed traveling along the shoulder of the freeway. The licensee did not update R1 and R2's appraisals following the incident which can cause a potential health and safety risk to the residents.
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Type B
08/26/2026
Section Cited
CCR87458(b)

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(b) The licensee shall obtain an updated medical assessment when required by the Department.
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Licensee shall obtain updated medical assessments/Physician’s Reports for R1 and R2 and submit copies to CCLD by the POC due date.
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Based on records review, R1's Physician's Report is dated 03/05/2024 and R2's Physician's Report is dated 02/10/2020. Following the incident on 07/25/2026, in which R1 and R2 left the facility unassisted, and were observed walking along the shoulder of the freeway, the facility did not obtain updated medical assessments for R1 and R2 as required by the Department which poses a potential health and safety risk to residents 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:
Ardalan Gharachorloo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/12/2026 03:03 PM - It Cannot Be Edited


Created By: Ardalan Gharachorloo On 08/12/2026 at 01:26 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: 08/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2026
Section Cited
CCR
87211(a)(1)(D)

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(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days...(D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.
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Licensee shall submit the incident report for R1 and R2 to CCLD, review the regulation, and provide a letter of attestation to LPA by the POC due date.
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Based on records review and interview, R1 and R2 left the facility on 07/25/2026, became lost, and were observed walking along the shoulder of the freeway. The facility did not submit a written incident report to CCLD regarding the incident within seven days of the occurrence which posed a potential risk to the health and safety of residents 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:
Ardalan Gharachorloo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
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