Community Care Licensing

Document Has Been Signed on 05/08/2024 08:06 PM - It Cannot Be Edited

FACILITY NAME:	OAK HILLS RESIDENTIAL FACILITY		FACILITY NUMBER:	075600407
ADMINISTRATOR/ DIRECTOR:	LAPASA, EDNULFO & REBECCA		FACILITY TYPE:	735
ADDRESS:	141 GREENMEADOW CIRCLE		TELEPHONE:	(925) 709-8853
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY: 6		CENSUS: 4	DATE:	05/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:25 PM
MET WITH:	Quent Lapasa, Caregiver		TIME VISIT/ INSPECTION COMPLETED:	08:20 PM

SUPERVISORS NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Laura Hall LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024

FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY	FACILITY NUMBER: 075600407
	VISIT DATE: 05/08/2024

Link to Parent Document Below:

FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY	FACILITY NUMBER: 075600407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

Type A

Section Cited

CCR

80087(g)

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in having toxins inaccessible which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2024
	Plan of Correction
1 2 3 4	Adminstrator agreed to lock away toxins and submit photo to CCLD by POC date.

Type A

Section Cited

CCR

80078(a)

(a) The licensee shall provide care and supervision as necessary to meet the client's need. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, and interview, the licensee did not comply with the section cited above in having staff present to supervise clients which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/09/2024
	Plan of Correction
1 2 3 4	Staff arrived at facility at 4:38pm. Deficiency cleared during visit.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Laura Hall LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024

Link to Parent Document Below:

FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY	FACILITY NUMBER: 075600407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

Type B

Section Cited

CCR

80020(c)

(c) A licensee of an Adult Residential Facility or Group Home utilizing secured perimeters shall conduct fire and earthquake drills pursuant to Health and Safety Code section 1531.15(h). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in conducting fire drills which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2024
	Plan of Correction
1 2 3 4	Administrator agreed to conduct a fire drill and submit a documented copy to CCLD by POC date.

Type B

Section Cited

CCR

80072(a)(3)

(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in having food unlocked for clients which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2024
	Plan of Correction
1 2 3 4	Caregiver removed padlock and chain immediately. Deficiency cleared during visit.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Laura Hall LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024

Link to Parent Document Below:

FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY	FACILITY NUMBER: 075600407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

Type B

Section Cited

CCR

80070(a)

80070 Client Records (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in having all client records current and complete which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2024
	Plan of Correction
1 2 3 4	Administrator agreed to update all client files and submit self-certification that it has been completed to CCLD by POC date.

Type B

Section Cited

CCR

80066(c)

(a) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. removal of records shall be subject to the following requirements: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in having staff records available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2024
	Plan of Correction
1 2 3 4	Administrator agreed to have staff records available for review and submit self-certification that it has been done to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Laura Hall LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024

Link to Parent Document Below:

FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY	FACILITY NUMBER: 075600407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2024

Type B

Section Cited

CCR

85064(f)

(f) When the administrator is absent from the facility there shall be coverage by a designated substitute, who meets the qualifications of Section 80065, who shall be capable of, and responsible and accountable for, management and administration of the facility in compliance with applicable law and regulation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in having a qualified backup administrator while absent which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2024
	Plan of Correction
1 2 3 4	Administrator agreed to implement a plan for a qualified backup administrator while absent and submit plan to CCLD by POC date.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Laura Hall LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024

FACILITY NAME: OAK HILLS RESIDENTIAL FACILITY	FACILITY NUMBER: 075600407
	VISIT DATE: 05/08/2024