<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201493
Report Date: 03/17/2026
Date Signed: 03/17/2026 06:12:25 PM

Substantiated


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
03/13/2026 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20260313101254
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: 12DATE:
03/17/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Digna Ramos, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate care and supervision to a resident
Staff verbally abused a resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/17/2026 at 1:00 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a 10-day initial complaint and deliver for the above allegations and met with care staff, Jason Salvador. Administrator (ADM) Dina Ramos was informed via phone regarding the purpose of the visit. ADM arrived around 3 PM.

Allegation: Staff did not provide adequate care and supervision to a resident. Substantiated

LPA conducted interviews with the Administrator, staff, and 12 residents. Based on information obtained through interviews, it was determined that the staff did not provide adequate care and supervision for a resident. Witness statements from W1 and W9 indicated that they observed and heard that staff member S6 did not respond when R1 called for assistance. Additionally, S1 and S3 reported that they witnessed and/or heard that S6 did not assist R1 at the time help was requested.

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

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
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 3
Control Number 15-AS-20260313101254
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: 03/17/2026
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...

The evidence supports that staff failed to adequately monitor and respond to the residents’ needs, resulting in a lapse in supervision. This deficiency poses a potential health and safety risk to residents in care. Therefore, the allegation is substantiated.

Allegation: Staff verbally abused a resident- Substantiated

LPA conducted interviews with the Administrator, staff, and 12 residents. Information obtained through these interviews determined that staff engaged in verbal abuse toward a resident. Witness statements from W1 and W9 indicated that they observed and heard staff member S6 speak in an inappropriate and verbally aggressive manner toward R1. Additionally, S1 and S3 reported that they also witnessed and/or overheard the interaction, corroborating concerns regarding S6’s conduct.

The preponderance of evidence supports that staff behavior was inconsistent with providing respectful and appropriate care and constitutes verbal abuse. This violation poses a potential risk to the resident’s emotional well-being and personal rights. Therefore, the allegation is substantiated.

An exit interview is conducted, and a copy of the appeal rights and report is provided via email.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20260313101254
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2026
Section Cited
CCR
87468.2(a)(4)
1
2
3
4
5
6
7
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:

This requirement is not met as evidenced by:

(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
1
2
3
4
5
6
7
Administrator(ADM) agree that ADM will review and re-train all staff on supervision requirements and resident care needs to ensure compliance with regulations. Submit attance and traning topic to CCLD by POC date.
8
9
10
11
12
13
14
Based on information obtained through interviews, it was determined that the staff did not provide adequate care and supervision for a resident. Witness statements from W1 and W9 indicated that they observed and heard that staff member S6 did not respond when R1 called for assistance.
8
9
10
11
12
13
14
Type B
03/24/2026
Section Cited
CCR
87468.1(a)(1)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator (ADM) agree to provide Proof of training, updated supervision plan, and a statement of understanding will be submitted to CCLD by the POC due date.
8
9
10
11
12
13
14
Base on information obtained through these interviews determined that staff engaged in verbal abuse toward a resident. Witness statements from W1 and W9 indicated that they observed and heard staff member S6 speak in an inappropriate and verbally aggressive manner toward R1.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3