019200695-4-10-2026-15-AS-BFOG-DTZ3YE-20260511183950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200695
Report Date: 04/10/2026
Date Signed: 04/10/2026 12:48:45 PM

Unsubstantiated

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
04/03/2026 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20260403165245

FACILITY NAME:	GOOD SHEPHERD VISTA		FACILITY NUMBER:	019200695
ADMINISTRATOR:	KOO, HASMIN		FACILITY TYPE:	740
ADDRESS:	5472 FOOTHILL BLVD		TELEPHONE:	(510) 534-5734
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	26	CENSUS: 22	DATE:	04/10/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Hasmin, Koo, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not seek medical attention for a resident in care.
Staff did not prevent a resident in care from sustaining falls.
Staff did not allow a resident to receive phone calls.
Staff are not bathing a resident in care.

INVESTIGATION FINDINGS:

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On 4/10/2026 at 9:00 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a complaint investigation and to deliver complaint findings for the allegations above. LPA met with Caregiver/Lead Staff, Stephanie Griffiths, and explained the purpose of the visit. Administrator (ADM), Hasmin Koo, arrived at a later time.

During the investigation, LPA interviewed 5 residents, ADM, 4 staff, contacted 2 witnesses via phone, and the complainant. LPA reviewed and obtained documents, including LIC500, the physician's report, care plan, house rules, conservatorship documents, court order documents, and emergency information.

Report Continue on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

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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Control Number 15-AS-20260403165245

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: GOOD SHEPHERD VISTA	FACILITY NUMBER: 019200695
	VISIT DATE: 04/10/2026

NARRATIVE

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Finding: Staff Did Not Seek Medical Attention for a Resident in Care – Unsubstantiated

Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that medical attention is sought promptly whenever a resident is injured, becomes ill, or expresses a need for medical care. Additionally, five (5) resident interviews indicated that staff do seek medical attention when needed. An interview with the complainant further confirmed that the facility did, in fact, seek medical attention for Resident 1 (R1) while in care.

Finding: Staff did not prevent a resident in care from sustaining falls – Unsubstantiated

Licensing Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that residents identified as fall risks are provided with appropriate supervision and assistance in accordance with their care plans. Staff reported that preventative measures, including monitoring, reminders, and assistance with ambulation, are implemented to reduce the risk of falls. LPA also interviewed five (5) residents, who indicated that staff are available to assist when needed. Residents reported that staff respond to requests for help and provide support with mobility and daily activities. In addition, LPA reviewed relevant facility records, including but not limited to incident reports, care plans, and physicians’ reports. Documentation reviewed did not indicate that staff failed to implement appropriate fall prevention measures or that neglect contributed to resident falls.

Report Continue on LIC9099C1...

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260403165245

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: GOOD SHEPHERD VISTA	FACILITY NUMBER: 019200695
	VISIT DATE: 04/10/2026

NARRATIVE

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Finding: Staff did not allow a resident to receive phone calls- Unsubstantiated

Licensing Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that residents are permitted to receive phone calls. Staff reported that Resident 1 (R1) has, at times, refused to accept phone calls. LPA also interviewed five (5) residents, who indicated that they are allowed to receive phone calls and that staff do not restrict access. Residents further reported that R1 has declined phone calls on occasion. In addition, LPA reviewed relevant documentation, including court records. LPA observed a court order granting R1’s conservator the authority to deny and/or limit visitation and communication, including phone calls.

Finding: Staff are not bathing a resident in care- Unsubstantiated

Licensing Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that residents are assisted with bathing in accordance with their needs and established shower schedules. Staff reported that assistance is provided twice a week or as required and that residents are encouraged to maintain personal hygiene. LPA also interviewed five (5) residents, who indicated that staff assists with bathing and that they can shower regularly. Some residents reported that they choose their preferred bathing times or occasionally decline assistance. In addition, LPA reviewed facility documentation, including shower schedules, which indicate that bathing assistance is scheduled and provided to residents as needed.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegations are UNSUBSTANTIATED.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC9099 (FAS) - (06/04)

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