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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200765
Report Date: 05/11/2023
Date Signed: 05/11/2023 05:00:21 PM


Document Has Been Signed on 05/11/2023 05:00 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: 44DATE:
05/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Reynaldo "Jun" Gutierrez, Business Ofiice ManagerTIME COMPLETED:
05:15 PM
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On 05/11/2023 at 2:45 PM, Licensing Program Analyst (LPA) L. Alexander and Licensing Program Manager, J Fong arrived unannounced to conduct a Case Management regarding ongoing discussion pertaining to a capacity increase. LPA and LPM met with Business Office Manager, Reynaldo "Jun" Gutierrez and explained the reason for visit.

LPA and LPM reviewed physical plant changes being proposed and observed that there is a bathroom that is next to the entrance hallway, and currently a staff room on the opposite side of the bathroom from the hallway. As explained to LPA and LPM, a door will need to be cut out from the hallway to lead into a small alcove/hallway and the staff room to be converted into a new, shared resident room. The bathroom will be modified to accommodate the alcove, and a wall removed so that it flows into an adjoining shower area. There is a second room currently serving as a conference room further down the entrance hallway and to the side of the previously referenced bathroom and staff room. This room will also be converted into a shared room. A door will need to be cut out between this room and the aforementioned bathroom - which will become a shared "Jack and Jill" bathroom for the two rooms to be converted. Lastly, there is a room that has already been constructed near the kitchen.

LPM advised facility designee that the proposed work would constitute an alteration/modification to the physical plant and per Title 22 regulations requires

Continued on 809C...
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/11/2023
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a permit. LPM advised facility designee that contact should be made with the County to discuss the changes to the physical plant, obtain the permit (or a statement in writing from the County that they will not need to issue one), then submit to CCLD a written statement describing the work to be performed, how the residents will be kept safe from hazards during the construction, a copy of the permit, and a copy of what will be the final facility sketch.

No Deficiencies cited. A copy of this report and the Title 22 Regulation pertaining to RCFE modifications/alterations were provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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