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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200672
Report Date: 09/29/2025
Date Signed: 09/29/2025 01:18:02 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
09/25/2025 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20250925114054
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:
09/29/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee/Administrator Victoria PurugananTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff moved resident's room into a common area.

Staff leave residents unattended.
INVESTIGATION FINDINGS:
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On 09/29/2025 at 10:30 AM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to open a 10-day initial visit and to deliver findings for the allegations above. LPAs met with Licensee/Administrator Victoria Puruganan and explained the reason for the visit.

During the course of the investigation, LPAs toured the facility, inspected all residents’ rooms, obtained and reviewed copies of the staff schedules for August and September.

Allegations: Staff moved resident's room into a common area.

Investigation Finding: It was reported to the department that the licensee is moving a resident to a converted room which is not up to code The licensee has converted living room space into a bedroom, and other residents have access to this common area.

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

DATE: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
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-20250925114054
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: 09/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2025
Section Cited
CCR
87307(a)(2)(B)
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87307 Personal Accommodations and Service (a) Living accommodations…facility shall…provide…accommodations and privacy for… residents…shall apply: (2) Resident bedrooms shall…(B) No…used for other purposes shall be used as a sleeping room for any resident.
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By POC date, Licensee will move resident into a private room. Licensee will submitt photos to LPA.
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Based on observation, the licensee did not comply with the section cited above by having a resident's sleeping quarters in commmon area which posed a potential health and safety risk to persons in care.
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Type A
09/30/2025
Section Cited
CCR
87468.2(a)(4)
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To care, supervision, and ...meet their individual needs...by staff that are sufficient in numbers, qualifications, and competency...

This requirement was not met as evidence by:
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By POC date, Licensee will schedule sufficient staff to cover 10:00 PM to 6:00 AM and submitt staff schedule to LPA.
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Based on interview, the licensee did not comply with the section cited above by not having staff scheduled 10:00 PM to ^:00 AM which posed a potential health and safety risk to persons in care.
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An Immediate and repeat Civil penalty assessed $1000.00
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: 09/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250925114054
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: 09/29/2025
NARRATIVE
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Continued from LIC9099

During investigation, LPAs toured the facility and observed a resident, R1, occupying a space in the living room that has been converted into a bedroom that is not fire cleared nor on the original facility sketch. Therefore, this allegation is SUBSTANTIATED.

Allegations: Staff leave residents unattended.

Investigation Findings: It was reported to the department that there are no night staff on the premises. LPAs reviewed the staff schedule for August and September, and found there were no specific times listed for staff shifts. LPAs spoke with S1 and discovered that there are no listed times for the shifts due to inconsistent number of staff on shift S1 also reported that there are no staff scheduled 10:00 PM to 6:00 AM. Therefore, this allegation is SUBSTANTIATED.

The preponderance of evidence is met; therefore, the allegations are substantiated. Deficiencies are 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: 09/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3