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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201493
Report Date: 12/18/2025
Date Signed: 12/18/2025 11:52:23 AM

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
12/12/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20251212192124
FACILITY NAME:GRAND OAK MANOR SUITE II LLCFACILITY NUMBER:
019201493
ADMINISTRATOR:RAMOS, DIGNAFACILITY TYPE:
740
ADDRESS:999 TORRANO AVETELEPHONE:
(510) 200-9001
CITY:HAYWARDSTATE: CAZIP CODE:
94542
CAPACITY:14CENSUS: 10DATE:
12/18/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jason Salvador, Care Staff TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not address a pest infestation
INVESTIGATION FINDINGS:
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On 12/18/2025 at 9:00AM, Licensing Program Analysts (LPAs) Kelly Nguyen and Andrew Christy arrived unannounced to open a 10 Day Complaint Investigation and deliver findings. LPAs met with Cre staff Jason Salvador and explained the nature of the visit. Administrator Digna Ramos was contacted and could not be available in person, and stated that caregivers have permission to sign any forms.

During the course of investgation LPAs conducted interviews with care staff and residents. LPAs toured facility, including but not limited to 7 bedrooms, 3 bathrooms, kitchen, common areas, living room, and garage.

Allegation: Staff did not address a pest infestation- Unsubstainted

Report continued on LIC 9099c...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
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-20251212192124
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: GRAND OAK MANOR SUITE II LLC
FACILITY NUMBER: 019201493
VISIT DATE: 12/18/2025
NARRATIVE
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Per allegation, there is vermin in the residents' rooms eating food in the rooms. During the tour of the facility, LPAs checked all resident rooms and observed that there are droppings in all of the residents room. However, interview conducted with Staff 1 (S1) and documents reviewed the facility is contracted with a pest prevention company (Official Pest Prevention an anticimex) that install three smart meter around the facility and is monitoring the facility with pest concern.

This agency investigated the allegation above. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2