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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200672
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:37:20 PM


Document Has Been Signed on 09/12/2024 12:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



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: 11DATE:
09/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jezrael Pascual Office ManagerTIME COMPLETED:
01:15 PM
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On 09/12/2024 at 8:45 AM, Licensing Program Analysts (LPAs) D. Doidge and J. Sampair arrived to conduct an unannounced Plan of Correction (POC) inspection. Upon entry into the facility, the LPAs identified themselves and the purpose of the visit to Office Manager Jezrael Pascual. At facility Administrator Victoria Puruganan was called and asked if proof of correction had been sent. It had not..

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 421F..

A $1,400 civil penalty is assessed today;

Exit interview conducted and a copy of this report was provided..

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: David DoidgeTELEPHONE: (916) 475-5913
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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