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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201060
Report Date: 11/07/2024
Date Signed: 11/07/2024 06:48:28 PM

Document Has Been Signed on 11/07/2024 06:48 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:AEGIS LIVING PLEASANT HILLFACILITY NUMBER:
079201060
ADMINISTRATOR/
DIRECTOR:		LINDA L. FISHERFACILITY TYPE:
740
ADDRESS:1660 OAK PARK BLVDTELEPHONE:
(925) 939-2700
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 90CENSUS: 76DATE:
11/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:Linda L. Fisher, General ManagerTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 11/07/2024 at 3:40 PM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding a death that was reported to Community Care Licensing Division (CCLD) on 08/16/2024. LPA met with General Manager, Linda L. Fisher and explained the purpose of the visit. GM, Linda L. Fisher, had to leave and authorized Health Services Director, Davinderjit Singh, to sign the report.


On 08/16/2024 CCLD received a Death Report (LIC624A) that a caregiver found R1 laying on the floor by their bed. The report indicated that R1 was last seen by a Med Tech at around 11:15 AM and was reminded about lunch on 08/16/2024.

LPA interviewed S1 and they stated that the caregiver found R1 laying on the floor and that R1 was not breathing. S1 stated that 911 was called and the paramedics and police arrived. S1 stated that the paramedics arrived and assessed R1 but there was no sign of life. The LIC624A further indicated that paramedics pronounced R1 deceased on 08/16/2024 at approximately 12:30 PM. The LIC624A further indicated that R1 had a Do Not Resuscitate (DNR) on file. Police Officer investigated and called the coroner to remove the remains. Police Report #24-2378.

LPA reviewed and obtained a copy of R1's physician's report. LPA requested a copy of death certificate to be submitted to CCLD.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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