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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200672
Report Date: 09/24/2025
Date Signed: 09/24/2025 06:07:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
09/17/2025 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20250917130441
FACILITY NAME:OPAL CARE LLCFACILITY NUMBER:
019200672
ADMINISTRATOR:PURUGANAN, VICTORIAFACILITY TYPE:
740
ADDRESS:3917 OPAL STREETTELEPHONE:
(510) 420-0731
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY:15CENSUS: 9DATE:
09/24/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee/Administrator Victoria Puruganan TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not prevent residents room from being hazardous.
INVESTIGATION FINDINGS:
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On 09/24/2025 at 12:30 PM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to open a 10-day initial visit and to deliver findings for the allegation above. LPAs met with Licensee/Administrator Victoria Puruganan and explained the reason for the visit.

During the course of the investigation, LPAs conducted interviews with S1 and S2. LPAs toured the facility and inspected all residents’ rooms.

Allegations: Staff did not prevent residents room from being hazardous.

Investigation Finding: It was reported to the department that there is a room currently under construction being painted while a resident, R1, was in the room. S1 and S2 informed LPAs that R1 was in room 13 and that staff painted the room while R1 was in it. Room 13, according to the facility sketch, was originally a staff room not meant for residents. Room 13 is not fire cleared for residents.

Continied on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
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 3
Control Number 15-AS-20250917130441
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: OPAL CARE LLC
FACILITY NUMBER: 019200672
VISIT DATE: 09/24/2025
NARRATIVE
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Continued fro LIC9099

R1 has since moved out of the facility. LPAs observed exposed wires hanging in the corner of the room next to door, and room 13 smells of paint.

The preponderance of evidence is met; therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 809-D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12-month period may result in civil penalties.

Deficiency plan and proof of correction were discussed with Licensee/Administrator Victoria Puruganan.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250917130441
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: OPAL CARE LLC
FACILITY NUMBER: 019200672
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2025
Section Cited
CCR
97204)b)
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87204 Limitations - Capacity and Ambulatory Status
(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. .
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R1 has already moved out of the facility.
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Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents
Based on observation, the licensee did not comply with the section cited above by having a bedridden resident in a non-cleared room.
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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: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3