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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601222
Report Date: 11/21/2023
Date Signed: 11/21/2023 12:31:27 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
06/26/2023 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20230626092628
FACILITY NAME:CARDINAL POINT AT MARINER SQUAREFACILITY NUMBER:
015601222
ADMINISTRATOR:GERALD VADNAISFACILITY TYPE:
741
ADDRESS:2431 MARINER SQUARE DRTELEPHONE:
(510) 337-1033
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:153CENSUS: 105DATE:
11/21/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Avon Nguyen, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to follow reporting requirements
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/21/23 at 12:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings on the above allegation. LPA met with Avon Nguyen, Administrator and explained the purpose of the visit.

LPA reviewed C1’s file and found the facility followed all reporting requirements regarding the injury that occurred on 6/17/23 which included filing a LIC624 with CCL on 6/20/23 which is within the regulatory timeframe.

This agency has investigated the allegation that facility staff failed to follow reporting requirements. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted, a copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory ClarkTELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
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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