079200765-1-9-2025-15-AS-BFOG-DDD33G-20250128165327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200765
Report Date: 01/09/2025
Date Signed: 01/09/2025 01:26:58 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
04/18/2023 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230418112239

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: 49	DATE:	01/09/2025
		UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Liza Elegado, Executive Director		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Personal Rights

INVESTIGATION FINDINGS:

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On 01/09/2025 at 10:30 AM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director (ED) to deliver the findings of above allegation. LPA explained the purpose of the visit with Executive Director, Liza Elegado.

During investigation, the Department obtained the following documents from the facility – Physician’s Report, Admission Agreement, Preplacement Appraisal, Medication Administration Record (MAR), Case notes, Incident Reports, Emergency and Identification Information, Home Health Notes, Hospice notes, Appraisal Needs and Services Plan, Hospital Discharge, Personnel Report (April 2022), Service Request, Resident Assessment and Psychiatric Progress Notes, Power of Attorney, Death Report and Death Certificate.

LIC9099-C Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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-20230418112239

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: 01/09/2025

NARRATIVE

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LIC9099-C Continued...

Allegation: Questionable Death
Investigation Finding: Unsubstantiated

During investigation, the Department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. Review of R1’s medical documents showed that on 01/07/2022, R1’s primary diagnosis was unspecified depressive disorder. On 01/27/2022 R1 had an ER visit at Contra Costa Regional Medical Center for nicotine patch and redness in right ear. On 04/27/2022 Staff (S1) received a radio call approximately 1145-1300 that there was an emergency in R1’s room. S1 stated that they found R1 unresponsive while S2 was performing the Heimlich Maneuver. S1 stated that they began giving Cardiopulmonary Resuscitation (CPR) and dialed 911. S1 stated that Paramedics arrived and continued emergency resuscitation. S1 stated that R1 was admitted at John Muir Medical Center in Walnut Creek, CA. Per review of subject resident’s Needs & Services and interview resident was independent in eating and not a choking risk. Review of documents reports that R1 passed away on 05/04/2022 at 1312. Documents obtained do not suggest R1’s death was a result of neglect or lack of care for suspicious circumstances from facility staff.

Based on records review, interviews conducted, and observations made, the department has investigated the above allegation of questionable death and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation of questionable death is unsubstantiated.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC9099 (FAS) - (06/04)

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