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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201416
Report Date: 01/09/2025
Date Signed: 01/09/2025 01:42:56 PM

Document Has Been Signed on 01/09/2025 01:42 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:STRAWBERRY HILL AT GILL PORTFACILITY NUMBER:
079201416
ADMINISTRATOR/
DIRECTOR:		ASILUM, MARY KAROLINEFACILITY TYPE:
740
ADDRESS:2069 GILL PORT LNTELEPHONE:
(925) 448-2977
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 6CENSUS: 4DATE:
01/09/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Mary AsilumTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 1/9/2025 at 12:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to complete the pre-licensing of the facility after completing a Plan of Correction (POC) visit. Upon arrival, LPA stated the purpose of the visit to Caregiver Erma Dual.

The 3 A-Type and 2 B-Type citations were cleared. The Applicant Mary Asilum was not at the facility so the COMP III training was not completed. The LPA and Applicant scheduled a future date and time to conduct the COMP III training.

No citations issued.

Pre-Licensing is complete and this facility has no deficiencies.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
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.

LIC809 (FAS) - (06/04)
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