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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201423
Report Date: 04/15/2026
Date Signed: 04/15/2026 12:47:51 PM

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
12/15/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251215141851
FACILITY NAME:PURPLE HEARTS HOME CAREFACILITY NUMBER:
079201423
ADMINISTRATOR:BISAHA, JOYFACILITY TYPE:
740
ADDRESS:1206 DAINTY AVETELEPHONE:
(510) 894-5509
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:10CENSUS: 4DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Maria Walker, Caregiver TIME COMPLETED:
10:52 AM
ALLEGATION(S):
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Staff are not properly trained
Staff did not provide adequate care and supervision to a resident
Staff are inappropriately restraining a resident
INVESTIGATION FINDINGS:
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On 04/15/2026 at 10:23AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver findings for the allegations above. LPA met with Maria Walker, Caregiver and explained the reason for the visit. Administrator, Joy Bisaha arrived at approximately 11:09AM, LPA explained reason for visit.

During the course of investigation LPA toured facility, conducted interviews with witness (W1) and staff (S1, S2 and S3). LPA reviewed and obtained residents’ roster, staff schedule, staff training logs, resident’s (R1’s) admission agreement, medication log, physician’s report (LIC602) and unusual incident reports.

Continue on LIC9099...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 7
Control Number 15-AS-20251215141851
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: PURPLE HEARTS HOME CARE
FACILITY NUMBER: 079201423
VISIT DATE: 04/15/2026
NARRATIVE
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Continued from LIC9099


Staff did not provide adequate care and supervision to a resident

Interview with W1 revealed S2 and S3 are older and fragile and can’t provide physical care for R1, it’s difficult for S2 and S3 to handle R1 without assistance. Interviews with S2 and S3 revealed R1 was difficult to work with when R1 first arrive to facility, when R1 didn’t have medication to help with behaviors. Now that R1 is on medication, R1 is much easier to work with. Interview with S1 revealed facility is in the process of hiring more staff, which will allow more supervision of residents in care.

Staff are not properly trained

Record review revealed, staff received 20hrs of training in dementia care, postural support, restricted health conditions, hospice care, and medication administration. Record review and interviews with S2, and S3 revealed, staff have not received training related to residents’ behavioral challenges

Staff are inappropriately restraining a resident

Interviews with W1 revealed facility is keeping R1 restraint to keep R1 in the wheelchair. Interview with S1 revealed there was no physician order for the wheelchair belt, the facility was given permission from R1’s children to place a belt on the wheelchair to prevent R1 from sliding out and possibly falling on the floor.

Continued on LIC9099C.....

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 15-AS-20251215141851
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: PURPLE HEARTS HOME CARE
FACILITY NUMBER: 079201423
VISIT DATE: 04/15/2026
NARRATIVE
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LIC9099C....


Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.


Exit interview conducted and a copy of report was given.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 15-AS-20251215141851
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: PURPLE HEARTS HOME CARE
FACILITY NUMBER: 079201423
VISIT DATE: 04/15/2026
NARRATIVE
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Continued from LIC9099


Staff are not meeting the needs of a resident

Interviews with S1, S2 and S3 revealed R1’s needs are being me, R1 is given showers, meals three times a day with snack in between meals, and toileting needs are met daily.

Staff are not meeting a resident's incontinence needs

Interviews with W1, S1, S2 and S3 revealed staff have a difficult time changing R1. Interviews with S2 and S3 revealed they would have R1 stand against the wall, holding the grab bar in order to change R1’s diaper. Interviews also revealed licensees will come in a couple of days a week to assist with R1’s

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.


Exit interview conducted and a copy of report was given.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
12/15/2025 and conducted by Evaluator Tonica Syess-Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20251215141851

FACILITY NAME:PURPLE HEARTS HOME CAREFACILITY NUMBER:
079201423
ADMINISTRATOR:BISAHA, JOYFACILITY TYPE:
740
ADDRESS:1206 DAINTY AVETELEPHONE:
(510) 894-5509
CITY:BRENTWOODSTATE:CAZIP CODE:
94513
CAPACITY:10CENSUS: 4DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Maria Walker, Caregiver TIME COMPLETED:
10:52 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff are not meeting the needs of a resident
Staff are not meeting a resident's incontinence needs
INVESTIGATION FINDINGS:
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On 04/15/2026 at 10:23AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver findings for the allegations above. LPA met with Maria Walker, Caregiver and explained the reason for the visit. Administrator, Joy Bisaha arrived at approximately 11:09AM, LPA explained reason for visit.


During the course of investigation LPA toured facility, conducted interviews with witness (W1) and staff (S1, S2 and S3). LPA reviewed and obtained residents’ roster, staff schedule, staff training logs, resident’s (R1’s) admission agreement, medication log, physician’s report (LIC602) and unusual incident reports.


Continued on LIC9099C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 15-AS-20251215141851
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: PURPLE HEARTS HOME CARE
FACILITY NUMBER: 079201423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2026
Section Cited
CCR
87608(a)(3)
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(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions.
3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.
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BY POC date. Licensee agreed to read regulation 87608 and send a self certifying email to CCL
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This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in not having doctor orders for wheelchair belt for R1 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 Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 15-AS-20251215141851
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: PURPLE HEARTS HOME CARE
FACILITY NUMBER: 079201423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2026
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Additional staff shall be employed as necessary... This requirement is not met as evidenced by:
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By POC date. Licensee agreed to implement a plan to assist with staffing and submit plan to CCL.
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Based on interviews and record review the Licensee did not comply with the section cited above in not having sufficient supervision for residents, which posed a health and safety risk to persons in care.
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Type B
04/25/2026
Section Cited
CCR
87705(1)
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(1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation:
(A) Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living....
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By POC date. Licensee agreed to implement a plan on providing staff training and send plan to CCL
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This requirement is not met as evidenced by:
Based on record review and interviews the Licensee did not comply with he section cited above in not having staff trained as specified in section 87208, which posed a health and safety 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 Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7