079200765-3-12-2025-15-AS-BFOG-DEUVJH-20250317162842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200765
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:30:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20240605154741

FACILITY NAME:	PLEASANT HILL OASIS		FACILITY NUMBER:	079200765
ADMINISTRATOR:	ELEGADO, LIZA		FACILITY TYPE:	740
ADDRESS:	40 BOYD RD		TELEPHONE:	(925) 937-5348
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	49	CENSUS: 48	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Liza Elegado, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident sustained unexplained injury while in care.
Resident's hygiene needs are not being met.
Staff did not ensure that the resident had clean clothes.
Staff does not provide resident with appropriate bed linens.

INVESTIGATION FINDINGS:

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On 03/12/2025 at 10:30 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director, Liza Elegado, to deliver the findings of above allegations. LPA explained the purpose of the visit with Executive Director.

During investigation, the Department obtained the following documents from the facility – Physician's Reports, Needs and Services Plans, Resident Roster, Staff Roster, Narrative Charting, After-Visit Summaries, Admission Agreements, Pre-Placement Appraisals, Resident Assessment, MAR, Outside Agency/Services Documentation and Identification and Emergency Information.

LIC9099-C Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240605154741

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 OASIS	FACILITY NUMBER: 079200765
	VISIT DATE: 03/12/2025

NARRATIVE

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LIC9099-C (Page 2)

Allegation: Resident sustained unexplained injury while in care.
Finding: Unsubstantiated

On 06/11/2024, LPA interviewed Witness (W) W1. W1 stated that resident (R) R1’s neck appeared to be swollen and that R1 had tears in their eyes. W1 stated that it took R1 a long time to look up, there was dried up blood on R1’s face and they were also wearing a mask. LPA interviewed R1. R1 stated that they haven’t had any injuries, falls, been hurt or felt any pain and that no one has hurt them while at the facility.

Allegation: Resident's hygiene needs are not being met.
Finding: Unsubstantiated

On 06/11/2024, LPA interviewed W1. W1 stated that when they visited R1 they didn’t look clean. LPA interviewed R1 and R1 stated that they take showers and brush their teeth. LPA interviewed R1 that stated that they do take showers every week. LPA reviewed the Shower Schedule (as of 04/18/2024) and it shows that R1 is scheduled a shower 2 times a week on Sundays and Thursdays.

Allegation: Staff did not ensure that the resident had clean clothes.
Finding: Unsubstantiated

On 06/11/2024, LPA interviewed W1. W1 stated that R1’s clothes didn’t look clean and that their jacket looked like it was on the ground. LPA reviewed the “Laundry Day of Residents,” that showed R1’s laundry day is scheduled on Saturdays in the

LIC9099-C Continued...

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240605154741

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 OASIS	FACILITY NUMBER: 079200765
	VISIT DATE: 03/12/2025

NARRATIVE

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LIC9099-C (Page 3)

A.M. LPA interviewed R1 and R1 stated that their clothes get laundered weekly. LPA observed that R1 had clean clothes hanging in their closet and appeared clean during visit.

Allegation: Staff does not provide resident with appropriate bed linens.
Finding: Unsubstantiated

On 06/11/2024, LPA interviewed W1. W1 stated that 3 weeks back R1 had a white blanket, a tarp and a flat sheet on their bed. LPA interviewed staff and S1 and S2 stated that all residents have bed linen sheets, blanket and bed spread/comforter on their beds. LPA observed flat and fitted sheets along with a blanket on R1’s bed.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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