079200765-3-12-2025-15-AS-BFOG-DEXQHX-20250320121148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200765
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:33:49 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
02/14/2025 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20250214143406

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:	03:30 PM
MET WITH:	Liza Elegado, Executive Director		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff did not follow the directives of resident's doctor.
Staff are not able to effectively communicate with residents.

INVESTIGATION FINDINGS:

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On 03/12/2025 at 3:30 PM, 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 – Resident Roster, Room Assignment, Staff Roster including, but not limited to the following; Personnel records: Nurse & Med. Techs. training records.
Resident #1 (R1) records: LIC602, Resident Preplacement Appraisal, Move in Records - ID/Emergency contact information, Medication lists, MARs and After Visit Summary.

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-20250214143406

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: Staff did not follow the directives of resident's doctor.
Finding: Unsubstantiated

On 03/11/2025, LPA interviewed witness (W). W1 stated that resident (R) R1 told them that they were given a medication before their scheduled surgical procedure and was not supposed to take that medication.

On 03/12/2025, LPA interviewed staff (S). S1 stated that there were no doctor's orders instructing the Med Techs to not administer the medication. S1 stated that they were not informed by R1 that they were having a procedure until the day before. S1 stated that R1 will not give them any copies of doctor's orders or After Visit Summary when they are seen at the doctor or Emergency Room (ER). S1 stated that R1 is their own responsible party.

LPA reviewed the latest Physician's Report (LIC602-A) that indicates R1 is able to administer own prescription medication with an explanation, "but may need reminders." S1 stated that they called and spoke with the nurse care coordinator to get clarification and advised that the LIC602-A was not appropriate. S1 stated that R1 has an scheduled appointment with their primary care physician in April and will get the physician's report updated regarding medications and if they are able to leave the facility unassisted.

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-20250214143406

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)

Allegation: Staff are not able to effectively communicate with residents.
Finding: Unsubstantiated

On 03/11/2025, LPA interviewed W1 that stated R1 told them that the caregivers do not speak English.

On 03/12/2025, LPA interviewed S1 that stated all staff caregivers speaks English except for maybe one person. S1 stated that the caregiver speaks Spanish and that they use a translator on their phone to communicate. S1 stated that every shift including the NOC shift has at least one (1) caregiver that speaks English. S1 stated that the caregiver that speaks Spanish does know how to communicate in terms of giving care to the residents.

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 is 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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