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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600386
Report Date: 07/17/2025
Date Signed: 07/17/2025 04:28:04 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
07/15/2025 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20250715161132
FACILITY NAME:HARTNELL HOME CAREFACILITY NUMBER:
015600386
ADMINISTRATOR:PURUGANAN,VICTORIA C.FACILITY TYPE:
740
ADDRESS:2041 HARTNELL STREETTELEPHONE:
(510) 489-7290
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:6CENSUS: 3DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Victoria Puruganan, Administrator TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility does not ensure adequate staffing during the night shifts
INVESTIGATION FINDINGS:
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On July 17, 2025, at 3 pm, Licensing Program Analysts (LPAs) K. Nguyen and L. Alexander arrived unannounced to deliver findings on the above allegation. LPAs met with care staff Renato L. Tisico and explained the visit. Administrators were notified and gave verbal for care staff to sign the report.

Allegation: Facility does not ensure adequate staffing during the night shifts- Unsubstantiated

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

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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-20250715161132
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: HARTNELL HOME CARE
FACILITY NUMBER: 015600386
VISIT DATE: 07/17/2025
NARRATIVE
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During the investigation, LPAs reviewed the staff schedule (LIC500). LPAs reviewed the Residents' files. LPAs interviewed Resident 1 (R1), Resident 3 (R3), Administrator (ADM), Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), Staff 5 (S5), and Staff 6 (S6). R1 and R3 stated that there are always staff at the facility. R1 stated R1 heard from R1 room that staff are redirecting R3 back to R3 room, because R3 tends to yell and open other residents' rooms. R1 states “There are night staff at all times”. R3 states, “The facility does not have an issue with staff at night”. S1 and S2 are live-in care staff, and S1 is the main care staff for the night shift. LPAs interviewed S3, S4, S5, and S6 via phone; all stated that they are S1 and S2 staff relieved on their days off.

Based on interviews, the facility is ensuring adequate staffing during the night shifts.
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.

An exit interview is conducted, and a copy of this report is provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
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