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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201209
Report Date: 11/20/2024
Date Signed: 11/20/2024 02:11:24 PM

Unfounded


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
11/12/2024 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20241112162300
FACILITY NAME:GRAND OAK MANOR SUITE LLCFACILITY NUMBER:
079201209
ADMINISTRATOR:SOMES, JOSEFACILITY TYPE:
740
ADDRESS:945 FANED WAYTELEPHONE:
(925) 349-4239
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:4CENSUS: 1DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Digna Ramos, Administrator TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not report a change in administrator as required.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/20/2024 at approximately 1:30 pm Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit meeting with Administrator Digna Ramos. The purpose of the visit was to deliver findings on the above allegation.

During the course of the investigation, LPA J. Clancy-Czuleger interviewed Administrator and confirmed that S1 emailed the LPA for change of administrator documents on 5/27/2024. LPA responded on 5/28/2024 to obtaine additional documents for the change of administrator which S1 sent on 5/29/2024.

Based on information obtained, the allegation licensee did not report a change in administrator as required is closed as unfounded.

Exit interview conducted and a copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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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