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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200765
Report Date: 04/19/2023
Date Signed: 04/19/2023 12:21:32 PM


Document Has Been Signed on 04/19/2023 12:21 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:ELEGADO, LIZAFACILITY TYPE:
740
ADDRESS:40 BOYD RDTELEPHONE:
(925) 937-5348
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:44CENSUS: 42DATE:
04/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Liza "Gigi" Elegado, Executive DirectorTIME COMPLETED:
12:30 PM
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On 04/19/2023 at 10:30 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Hall arrived unannounced to conduct a Case Management regarding a capacity increase. LPAs met with Executive Director (ED), Liza "Gigi" Elegado and explained the purpose of the visit.

LPAs toured the facility with ED to view the floor plan for the requested capacity increase for 5 Residents. LPA observed rooms 17 and 19 were shared rooms. Room #17 was previously used for a single room, but fire clearance indicates room #17 could be used for a shared room also. LPA L. Alexander received an updated Administrative Organization (LIC 309) on 1/23/2023 indicating that the interest in the corporation has changed to one (1) person having 100% interest in the LLC. LPA spoke with the owner, via speaker phone to get an understanding of his ownership and the change of ownership took place. LPA also inquired about the construction of the new rooms 24 & 25. The owner stated that rooms 24 and 25 will be constructed and all documents will be submitted to CCL before the capacity increase request. ED will submit a copy of the previous Administrative Organization to CCLD.

Exit interview conducted. Copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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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