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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201416
Report Date: 09/30/2025
Date Signed: 09/30/2025 06:49:20 PM

Document Has Been Signed on 09/30/2025 06:49 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: 5DATE:
09/30/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Caregiver Julie DualTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
NARRATIVE
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At 2:00 PM on 9/30/2025, Licensing Program Analyst (LPA) James Sampair arrived unannounced for this Case Management visit regarding the change of ownership and change of administrator notification received from Licensee / Administrator (ADM) Mary Asilum on 9/23/2025. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Caregiver Julie Dual.

The LPA interviewed Staff S1 and Staff S2 in person and Staff S3 and Staff S4 by telephone about the change in ownership and the change in ADM. Before arriving at the facility, the LPA discovered that S4, whom the ADM had stated was taking over ADM duties, had an expired ADM certificate. While at the facility, the LPA discovered that S3, who had been acting as ADM, had no ADM certificate at all.

During the inspection, the LPA discovered from record reviews that S3 was not associated with the facility and S1 was not fingerprint cleared.

2 Type-A and 1 Type-B citations were issued during this inspection (for details refer to LIC 809-D).

Deficiencies are cited from Title 22 California Code of Regulations (refer to LIC 809-D). Failure to submit proof of correction may result in additional civil penalty.

Exit interview conducted and a copy of the Appeal Rights, and this report provided.
NAME OF LICENSING PROGRAM MANAGER: Harpreet Humpal
NAME OF LICENSING PROGRAM ANALYST: James Sampair
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document is an Amendment of Original Document on 12/26/2025 09:00 AM

Citations on this Visit Report are Under Appeal!


Created By: Harpreet Humpal On 09/30/2025 at 05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 PORT
FACILITY NUMBER: 079201416

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
10/01/2025
Section Cited
CCR
87355(e)(2)

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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review . . . shall prior to working . . . in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by:
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On or before the due date, the Licensee has agreed to remove S1 from the facility until the CDSS Action Required Background Check ID: 7717780 per ID: 4600869903 has been completed to complete S1's fingerprint clearance process and to associate S1 with the facility.
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Based on record review, licensee did not comply with the section cited above. Staff S1 was not fingerprint cleared, which poses an immediate health and safety risk to the persons in care.
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Civil penalty of $500 is being assessed.
Deficiency Dismissed
Type A
10/01/2025
Section Cited
CCR87355(e)(3)

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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review . . . shall prior to working . . . in a licensed facility: (3) Request a transfer of a criminal record clearance . . . This requirement is not met as evidenced by:
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On or before the due date, the Licensee has agreed to not allow S3 to return to the facility until they have their background clearance transferred to this facility.
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Based on record review, licensee did not comply with the section cited above. Staff S3's fingerprint clearance had not been transferred to this facility, which poses an immediate health and safety risk to the persons in care.
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Civil penalty of $500 is being assessed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Isaac Taggart
NAME OF LICENSING PROGRAM MANAGER:
Harpreet Humpal
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/30/2025 06:49 PM - It Cannot Be Edited


Created By: James Sampair On 09/30/2025 at 05:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: STRAWBERRY HILL AT GILL PORT
FACILITY NUMBER: 079201416

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/07/2025
Section Cited
CCR
87405(a)

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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
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On or before the due date, the Licensee shall hire a certified Administrator.
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Based on interviews, Licensee did not comply with the section cited above. From interviews of Staff S1 through S4, it was established that Administrator (ADM) Mary Asilum has not been fulfilling the duties of an administrator for at least 6 weeks.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Harpreet Humpal
NAME OF LICENSING PROGRAM MANAGER:
James Sampair
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2025


LIC809 (FAS) - (06/04)
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