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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200765
Report Date: 01/09/2025
Date Signed: 01/09/2025 01:29:03 PM

Document Has Been Signed on 01/09/2025 01:29 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PLEASANT HILL OASISFACILITY NUMBER:
079200765
ADMINISTRATOR/
DIRECTOR:		ELEGADO, LIZAFACILITY TYPE:
740
ADDRESS:40 BOYD RDTELEPHONE:
(925) 937-5348
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 49CENSUS: 49DATE:
01/09/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:49 AM
MET WITH:Liza Elegado, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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On 01/09/2025 at 11:49 AM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management. LPA met with Executive Director (ED), Liza Elegado, and explained the purpose of the visit.

LPA L. Alexander conducted an Annual Inspection on 10/08/2024 and cited for deficiencies. The Plan of Correction (POC) original due dates was 10/09/2024, 10/24/2024, 10/25/2024, 10/31/2024, 11/08/2024 and 11/15/2024. LPA conducted a POC visit on 11/01/2024 in which there were deficiencies not cleared.

Deficiencies cleared today:
  • CCR 87355(e)(3)
  • CCR 87623(b)(2)(B)
  • CCR 87411(f)
  • CCR 87303 (a)
  • HSC 1569.618(c)(3)
  • HSC 1569.625 (b)(2)


Deficiency not cleared today:
  • CCR 87458(c)

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.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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Document Has Been Signed on 01/09/2025 01:29 PM - It Cannot Be Edited


Created By: Lori Alexander-Washington On 01/09/2025 at 12:44 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: PLEASANT HILL OASIS
FACILITY NUMBER: 079200765

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2025
Section Cited
CCR
87458(c)

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(c) The licensee shall obtain an updated medical assessment when required by the Department.

This requirement is not met as evidenced by:
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Administrator agreed to submit updated Physician's Reports (LIC602A) for R1 and R2 to CCLD by POC due date.
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Based on record review, the licensee did not comply with the section cited above in by having Physician's Reports that were over a year old and not updated for R1-R2 which poses a potential health, safety or personal rights risk to persons in care.
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Immediate Civil Penalty for $250.00 is being assessed today for repeat violation.

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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.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2025


LIC809 (FAS) - (06/04)
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