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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601156
Report Date: 01/01/2025
Date Signed: 01/03/2025 11:58:50 AM

Document Has Been Signed on 01/03/2025 11:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GOLDEN OASISFACILITY NUMBER:
015601156
ADMINISTRATOR/
DIRECTOR:		ZARAGOSA, EUFROCINA M.FACILITY TYPE:
740
ADDRESS:2312 - 10TH ST.TELEPHONE:
(510) 527-1073
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 10TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/01/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Eufrocina Zaragosa, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 12/30/24 at 1:40 PM, LPA L. Holmes arrived unannounced and attempted a required annual inspection. LPA observed the front gate to the driveway and entrance locked. LPA left a voicemail at the facility number and made contact with the Licensee on the cell number. The facility has zero clients and remain under construction. An announced visit is scheduled for 01/03/2024 at 9:30 AM..

On 01/03/24 at 9:45 AM, LPA L. Holmes arrived announced for a required annual inspection. LPA was greeted by Eufrocina Zaragosa, Administrator. The facility has zero (0) clients and remain under construction.

The facility is in disrepair (leaking pipes, buckling floors, Bosch Security Alarm System issues) there are no residents at the facility. Administrator will make corrections/renovations to the facility before accepting any residents. Administrator will contact CCLD as soon as the renovations are complete.

LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, and backyard. The facility consists of five (5) total bedrooms, and three (3) bathrooms. Bedrooms two (2) and (3) have water damage in the ceilings. No bodies of water observed. A comfortable temperature was maintained.

Continue on LIC809C...
Yvonne Flores-LariosTELEPHONE: (510) 286-0517
Lisha HolmesTELEPHONE: 510-286-4201
DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GOLDEN OASIS
FACILITY NUMBER: 015601156
VISIT DATE: 01/01/2025
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Continue from LIC 809

LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars, and are in sanitary condition.

Fire extinguisher was last serviced on 04/25/2022, observed full and to be serviced. First aid kit complete.

The following forms to be updated and submitted to CCLD prior to operation.
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility
-LIC610E Post Emergency Disaster Plan
-An updated copy of Administrator Certificate(s)

Exit interview conducted and a copy of this report provided to ADM.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC809 (FAS) - (06/04)
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