<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601374
Report Date: 02/20/2025
Date Signed: 02/20/2025 02:54:51 PM

Document Has Been Signed on 02/20/2025 02:54 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:AEGIS ASSISTED LIVING OF FREMONTFACILITY NUMBER:
015601374
ADMINISTRATOR/
DIRECTOR:		TURNER, RYANFACILITY TYPE:
740
ADDRESS:3850 WALNUT AVENUETELEPHONE:
(510) 739-1515
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 110CENSUS: 75DATE:
02/20/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:43 PM
MET WITH:Ryan Turner, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/20/25 at 2:43PM, Licensing Program Analyst (LPA) Daisy Panlilio arrived unannounced to conduct a case management visit in response to a priority 1 complaint received on 04/09/24. LPA met with Executive Director (ED) and explained the purpose of the visit.

Reporting party (RP) stated that review of video footage on 03/03/24 showed a male memory care resident (R5) entered resident's (R1) bedroom at 0449 hours and stayed there until 0600 hours. RP stated that R1's bedroom had a motion sensor that would alert staff of any movements inside. RP stated that no staff came to remove R5 from R1's room. R5 left the room on his own at 0600 hours. RP also stated she observed memory care residents left unsupervised in the common room of the memory care unit while she was visiting R1 on May 2024.

LPA interviewed ED who stated that he discussed the incidents with RP and conducted in-service staff retraining regarding proper care and supervision of residents with dementia on 04/12/24.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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 1