019200672-4-14-2021-15-AS-HHUL-C29PAH-20210420110846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200672
Report Date: 04/14/2021
Date Signed: 04/14/2021 02:30:41 PM

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
04/27/2020 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20200427135814

FACILITY NAME:	OPAL CARE LLC		FACILITY NUMBER:	019200672
ADMINISTRATOR:	PURUGANAN, VICTORIA		FACILITY TYPE:	740
ADDRESS:	3917 OPAL STREET		TELEPHONE:	(510) 420-0731
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94609
CAPACITY:	15	CENSUS: 7	DATE:	04/14/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Victoria Puruganan		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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On 04/14/2021 , Licensing Program Analyst (LPA) L. Ibo had an unannounced visit via telephone to deliver the findings for the above allegation. Due to the Executive Order for shelter-in-place set forth by the Governor, LPA was not able to deliver the findings in person. LPA spoke with Victoria Puruganan Administrator and explained the reason for the visit.

During investigation , S1 admitted that facility did not issue proper eviction notice to R1 and just told R1 to go back to VA which then based on the report R1 stayed at VA for 2 days.

The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 is being cited on the attached LIC 9099-D.
Exit interview conducted with Administrator . Appeals rights and copy of report given.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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-20200427135814

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: OPAL CARE LLC	FACILITY NUMBER: 019200672
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/07/2021 Section Cited CCR 85068.5(b)(1)	1 2 3 4 5 6 7	85068.5 Eviction Procedures(b) The licensee shall be permitted to evict a client by serving the client with a three-day written notice to quit provided ...(1) The licensing agency has granted prior written and/or documented telephone approval for the eviction. This requirement is not met as evidenced by	1 2 3 4 5 6 7	Facility administrator and ALL staff will review the process of proper eviction of clients, this training should be documented and be submitted to LPA on or before May 7, 2021.
	8 9 10 11 12 13 14	Based on interview and records review; Administrator did not comply with the section cited above. Administrator did not follow proper eviction process, Administrator admitted not informing licensing office about the eviction of R1, which poses a potential Health, Safety, or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021

LIC9099 (FAS) - (06/04)

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