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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601151
Report Date: 12/14/2021
Date Signed: 12/14/2021 05:14:38 PM



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
12/10/2021 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20211210150033
FACILITY NAME:AG HEALTH CARE, INC.FACILITY NUMBER:
075601151
ADMINISTRATOR:OSHINOWO, ANTHONYFACILITY TYPE:
740
ADDRESS:135 LOS CERROS AVENUETELEPHONE:
(925) 935-9626
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:6CENSUS: 5DATE:
12/14/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Anthony OshinowoTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Administrator failed to follow infection control protocol.
INVESTIGATION FINDINGS:
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On 12/14/2021 at 2:30PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced and met with ADM Anthony Oshinowo. The LPA explained the reason for the visit to Mr. Oshinowo. The allegation was that he had returned to the facility after international travel against infection control protocols, which created a potential health and safety risk to the residents. Based on a review of the guidance from county, state, and federal agencies and an interview of Mr. Oshinowo, LPA Sampair determined that he had returned to the facility before the strictest of those quidelines called for, which was to remain away from work for a period of 10 days.

Based on LPA’s record review and interview, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 has been cited.

Exit interview conducted. A copy appeal rights, and this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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-20211210150033
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: AG HEALTH CARE, INC.
FACILITY NUMBER: 075601151
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/14/2021
Section Cited
CCR
87468.1(a)(2)
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(a) Residents in all ... facilities ... shall have all of the following personal rights: ... (2) To be accorded safe, healthful and comfortable accommodations.

This requirement is not met as evidenced by:
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ADM Anthony Oshinowo has already completed the correction by completing the Covid-19 testing.
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Based on an interview and review of the records, the licensee did not comply with the section cited above when ADM Anthony Oshinowo entered the facility within 10 days of his international travel, which posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2