019201493-2-26-2026-15-AS-BFOG-DSA63Z-20260317202758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201493
Report Date: 02/26/2026
Date Signed: 02/26/2026 10:43:40 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
02/18/2026 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20260218095146

FACILITY NAME:	GRAND OAK MANOR SUITE II LLC		FACILITY NUMBER:	019201493
ADMINISTRATOR:	RAMOS, DIGNA		FACILITY TYPE:	740
ADDRESS:	999 TORRANO AVE		TELEPHONE:	(510) 200-9001
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94542
CAPACITY:	14	CENSUS: 12	DATE:	02/26/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Digna Ramos, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not issue resident a refund
Staff did not provide resident with records

INVESTIGATION FINDINGS:

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On 2/26/2026 at 8:00 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a 10-day initial complaint and deliver for the above allegations, met with Administrator (ADM) Dina Ramos, and explained the purpose of the visit.

During the course of the investigation, LPA conducted an interview with the Administrator, RP, and RPB.
Allegation: Staff did not issue the resident a refund

This allegation was investigated on 12/04/2025 under control number 15-AS-20251204095734. On 02/18/2026, the LPA conducted interviews with the Reporting Party (RP) and the Responsible Party Brother (RPB).

Report continued on LIC 9099c...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260218095146

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: 02/26/2026

NARRATIVE

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The RP stated they did not file a complaint regarding a refund and reported that their brother was responsible for payment for the stay at the facility. The RPB stated they did not file a complaint regarding a refund and reported that the facility contacted them to explain the situation. The RPB further stated that the Administrator established a payment plan and confirmed the facility had issued the first refund payment. Based on information obtained during the investigation, the allegation is found to be unsubstantiated.
Allegation: Staff did not provide the resident with records

During the course of the investigation, the LPA interviewed the Reporting Party (RP) on 2/18/26 and the Administrator on 2/26/26. The RP reported that the facility did not complete a form requested by State Farm and that the requested information was not received. The RP later acknowledged that, after clarification, they were responsible for directly requesting the document from the facility and providing authorization for the release of information. The RP stated they initially believed the facility was responsible for submitting the information; however, the facility is unable to release personal information without proper consent. Based on information obtained during the investigation, the allegation was found to be unsubstantiated.

This agency investigated the allegation above. Although the allegations may have happened or are 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 is provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC9099 (FAS) - (06/04)

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