019200732-1-5-2026-15-AS-BFOG-DQ3U2X-20260106141241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200732
Report Date: 01/05/2026
Date Signed: 01/05/2026 10:45:55 AM

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
12/26/2025 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20251226155454

FACILITY NAME:	AMBER HOUSE CRISIS RESIDENTIAL		FACILITY NUMBER:	019200732
ADMINISTRATOR:	BENJAMIN BLAKE		FACILITY TYPE:	772
ADDRESS:	516 31ST ST		TELEPHONE:	(510) 379-4394
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94609
CAPACITY:	16	CENSUS: 8	DATE:	01/05/2026
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	VP of Operations Gary Tia.		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Uncleared adult supervising residents

INVESTIGATION FINDINGS:

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On 012/05/2026 at 8:20 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regards to the allegation above. LPA met with Caregiver Courtney Loni Graves and explained the purpose of the visit. Director of Crisis, Megan Cronin was notified by phone of the visit. Gary Tia VP of Operations arrived at 10:14 AM.

During the course of the investigation, LPA obtained copy of the facility’s staff roster, and names of four (4) staff present at the time of the visit.

Allegations: Uncleared adult supervising residents.

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

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-20251226155454

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: AMBER HOUSE CRISIS RESIDENTIAL	FACILITY NUMBER: 019200732
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/05/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/06/2026 Section Cited CCR 81019(e)(4)	1 2 3 4 5 6 7	Criminal Record Clearance (e) All individuals subject…pursuant to HHSC 1522 shall…(4) Request and be approved …criminal record exemption…be present at the facility.	1 2 3 4 5 6 7	Administrator agrees to either remove uncleared staff or have uncleared staff have associated with facility. Administrator will provide self-certification to CCL by the POC due date.
	8 9 10 11 12 13 14	Based on observation, record review, and interview, the licensee did not comply with the section cited above. One staff member has been working at the facility without fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 01/05/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20251226155454

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: AMBER HOUSE CRISIS RESIDENTIAL	FACILITY NUMBER: 019200732
	VISIT DATE: 01/05/2026

NARRATIVE

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Continued from LIC9099.

Investigation Findings: It was reported to the department that management allows several adults to work in the facility who have not cleared by DOJ background checks. While in the facility, LPA checked the names of the staff present and found one staff, S3, was not on the facility's Guardian clearance list and had been working in the facility for two days in a row including today. Since S3 is not cleared, the allegation of Uncleared adult supervising residents is substantiated.

Based on information obtained, the preponderance of evidence is met, therefore the allegation is substantiated.

Deficiency is cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result an additional civil penalty. Civil Penalty $200 is assessed on today's date.

Deficiency and plan and proof of correction were discussed with VP of Operations as the Administrator was not available at the moment.

Exit interview conducted, Appeal Rights, and copy this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

LIC9099 (FAS) - (06/04)

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