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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601151
Report Date: 05/31/2024
Date Signed: 05/31/2024 05:04:06 PM

Unsubstantiated


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
05/28/2024 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240528234913
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: 4DATE:
05/31/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Caregiver Ordel AcupanTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek timely medical attention for a resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/31/2024 at 3:00 PM, Licensing Program Analyst (LPA) James Sampair arrived at the facility unannounced to conduct the initial 10-day complaint investigation of the allegation above. Upon entry, the LPA informed Caregiver Ordel Acupan of the purpose of the visit.

The complaint alleges that staff did not seek timely medical attention for a resident.
The LPA interviewed staff member S1, client C1, and client C2 about the blood spots observed on 5/17/2024 at C1's day program and if C1 had asked to see the doctor. No one interviewed confirmed that C1 had requested to see the doctor.

Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted. Appeal Rights and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 529-9416
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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