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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200672
Report Date: 09/24/2024
Date Signed: 09/24/2024 09:07:41 AM


Document Has Been Signed on 09/24/2024 09:07 AM - 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: 13DATE:
09/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jezrael Pascual Office ManagerTIME COMPLETED:
02:39 PM
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On 9/24/2024 at approximately 8:45 am, LPAs James Sampair and David Doidge conducted an Unannounced Case Management visit to deliver an amended civil penalty originally issued on 9/12/24, in the amount of $1,400. The LPAs met with Office Manager Jezrael Pascual and explained the purpose of the visit.

The amended civil penalty issued today is in the amount of $400 and supersedes the previous civil penalty of 9/12/24.

This report and the amended civil penalty were reviewed with the facility, and Appeal Rights were provided..
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: David DoidgeTELEPHONE: (916) 475-5913
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
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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