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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200672
Report Date: 07/15/2022
Date Signed: 07/15/2022 02:32:17 PM

Unfounded


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
03/22/2021 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20210322121853
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:
07/15/2022
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Victoria Puruganan, Administrator
Jezrael Pascual, Staff		TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff stole money from resident
Staff stole resident’s personal belongings
INVESTIGATION FINDINGS:
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On 07/15/22 at 2:25PM, Licensing Program Analysts (LPAs) D Panlilio and L Holmes conducted an unannounced subsequent visit and met with staff (S1) to deliver the findings of above allegations. LPAs explained the purpose of the visit with administrator on the phone who authorized S1 to act on her behalf and sign the reports.

Allegation: Staff stole money from resident
Investigation Finding: UNFOUNDED
Based on interviews and record reviews, resident (R1) and responsible party (W1) in charge of R1’s finances stated that no money was stolen from R1’s bank account. Both R1 and W1 confirmed the $2,500 was paid to the facility for R1’s monthly rent. Review of R1’s rental payment checks showed R1 purchased cashier’s checks from his bank for the months of November and December 2020 & January and February 2021 made payable to the facility. There is no reasonable basis for this allegation. Therefore, this allegation is unfounded.
Continued on next page, LIC 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
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 2
Control Number 15-AS-20210322121853
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
VISIT DATE: 07/15/2022
NARRATIVE
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Allegation: Staff stole resident’s personal belongings
Investigation Finding: UNFOUNDED
Based on interviews and record reviews, resident (R1) and responsible party (W1) confirmed that R1’s wallet was not stolen. R1 asked W1 to keep his wallet and personal belongings because he did not have a safe place to put them. Currently, W1 has possession of R1’s belongings. W1 stated she is in charge of R1’s finances and that there was no wallet stolen. This allegation has no reasonable basis. Therefore, it is unfounded.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2