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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200672
Report Date: 08/14/2024
Date Signed: 08/14/2024 03:33:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/05/2024 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20240405092549
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: 13DATE:
08/14/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jezrael Pascual, House ManagerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not prevent resident from verbally and physically abusing other residents in care.
Staff is overcharging resident for higher level of care that is not being provided.
Licensee does not ensure facility has basic supplies.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/14/24 at 10:30 a.m., Licensing Program Analyst (LPAs) Greg Clark and David Doidge arrived unannounced to deliver findings in regard to the allegations above. LPAs met with Jezrael Pascual, House Manager and explained the purpose of the visit.

Allegation: Staff does not prevent resident from verbally and physically abusing other residents in care.

LPAs interviewed 4 residents (R1, R2, R3 and R4) and all reported being happy with the care they are receiving at the facility and have no issues their housemates. They also reported that staff are quick to respond if they need help. This allegation is unsubstantiated.

***report continues on LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20240405092549
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OPAL CARE LLC
FACILITY NUMBER: 019200672
VISIT DATE: 08/14/2024
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
26
27
28
29
30
31
32
***report continues form LIC9099***

Allegation: Staff is overcharging resident for higher level of care that is not being provided.

LPAs reviewed R5, R6 and R7’s files. All 3 residents are diagnosed with dementia. LPAs reviewed the admission agreements for all 3 residents. LPA’s found that there was no increase in the rate residents were paying for services and that the rate matches the services outlined in the agreement. This allegation is unsubstantiated.

Allegation: Licensee does not ensure facility has basic supplies.

LPA’s toured the entire facility including the kitchen, dining room, bedrooms, bathrooms and storage areas. Based on observation the facility has all the necessary basic supplies to care for the residents. This allegation is unsubstantiated.

This agency has investigated the complaints alleging staff does not prevent resident from verbally and physically abusing other residents in care, staff is overcharging resident for higher level of care that is not being provided, and licensee does not ensure facility has basic supplies.



We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2