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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600407
Report Date: 03/30/2023
Date Signed: 03/30/2023 11:27:58 AM

Document Has Been Signed on 03/30/2023 11:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:OAK HILLS RESIDENTIAL FACILITYFACILITY NUMBER:
075600407
ADMINISTRATOR:LAPASA, EDNULFO & REBECCAFACILITY TYPE:
735
ADDRESS:141 GREENMEADOW CIRCLETELEPHONE:
(925) 709-8853
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 4DATE:
03/30/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Quent Lapasa, CaregiverTIME COMPLETED:
10:50 AM
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On 3/30/2023 at 09:35AM, Licensing Program Analysts (LPAs) L. Hall and C. Fowler arrived unannounced to conduct proof of correction (POC) visit. LPA met with Quent Lapasa, Caregiver, and explained the purpose of the visit. Administrator, Rebecca Lapasa, arrived at 10:15AM.

LPA spoke with Administrator on 3/8/2023. Administrator requested extension for age exceptions. LPA granted extension until 3/28/2023. As of today’s date self-certification and age exception request for four (4) clients have not been received.

Facility has the following deficiencies that were not cleared:

· 80070(a), LPA has not received self-certification that all client files have been updated.


· 85068.4(g), LPA have not received request for age exceptions for four (4) clients.

Civil Penalties for 80070(a) in the amount of $200.00 assessed immediately for the period of 3/29/2023 to 3/30/2023.

Civil Penalties for 85068.4(g) in the amount of $200.00 assessed immediately for the period of 3/29/2023 to 3/30/2023.



Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY
FACILITY NUMBER: 075600407
VISIT DATE: 03/30/2023
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Continued from LIC809.

Civil Penalties in the total amount of $400.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing civil penalties until deficiency is corrected.

Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2