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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200672
Report Date: 05/25/2021
Date Signed: 05/25/2021 04:22:15 PM

Document Has Been Signed on 05/25/2021 04:22 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:OPAL CARE LLCFACILITY NUMBER:
019200672
ADMINISTRATOR:PURUGANAN, VICTORIAFACILITY TYPE:
740
ADDRESS:3917 OPAL STREETTELEPHONE:
(510) 420-0731
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 15CENSUS: 6DATE:
05/25/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Victoria Puruganan, AdministratorTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Praveen Singh conducted this unannounced tele-visit with Administrator to address violations that were found during an investigation conducted by the Department. Due to the present shelter in place order by the Governor, this inspection was conducted via video-conference.

As part of an investigation related to Complaint Control No. 15-AS-20200626085416, filed on 6/26/20, the Department's Audit Division conducted a Trust Audit for this facility.

The Auditor’s investigation revealed that Administrator financially abused R1. Administrator admitted using R1’s True Link debit card to make unauthorized purchases. The auditor obtained R1’s bank statements from April to June 2020 detailing the unauthorized purchases by Administrator. The auditor determined that the total unauthorized purchases on the resident’s card is $3,527.65. True Link has refunded $2,015.08 leaving a balance of $1,512.57 to be refunded back to the resident.

In addition, Administrator did not have any Policies and Procedures in place to safeguard residents’ funds and did not follow or abide by her affidavit regarding client’s cash resources, which indicated cash resources will not be handled.

Deficiencies are cited per California Code of Regulations, Title 22, and begins on the next page. Failure to correct deficiencies may result in civil penalties.

Exit interview conducted and a copy of this report and Appeal Rights provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Praveen Singh
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2021
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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Document Has Been Signed on 05/25/2021 04:22 PM - It Cannot Be Edited


Created By: Praveen Singh On 05/25/2021 at 02:13 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: OPAL CARE LLC
FACILITY NUMBER: 019200672

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2021
Section Cited
CCR
87217(g)

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Safeguards for Resident Cash, Personal Property, and Valuables - (g) Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care, including, but not limited to…
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Administrator shall cease control of any and all residents’ cash resources and establish policies and procedures prior to handling the cash resources for any residents. Prior to handling any cash resources, Administrator shall obtain training on Safeguarding resident cash, personal property, and valuables.
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This requirement is not met as evidenced by Administrator's failure to establish policies and procedures to safeguard R1’s cash resources. Administrator possessed R1’s debit card but did not keep any accounting or records of purchases made and misappropriated R1’s funds.
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A statement regarding this POC will be sent to LPA Singh via email by POC date.
Type A
05/26/2021
Section Cited
CCR87405(d)(5)

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Administrator - Qualifications and Duties – (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.
(5) Good character and a continuing reputation of personal integrity.
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Administrator will write a statement detailing any remorse for misusing R1’s cash resources and actions that were and will be taken to protect residents’ rights, and cash resources from this point forward. Proof of correction will be sent to LPA Singh via email by POC date.
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This requirement is not met as evidenced by Administrator’s financial abuse of R1.
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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.
SUPERVISOR'S NAME:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Praveen Singh
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2021


LIC809 (FAS) - (06/04)
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