019200695-9-24-2025-15-AS-YFLS-DM7Q7Q-20251006115527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200695
Report Date: 09/24/2025
Date Signed: 09/24/2025 03:29:08 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
09/15/2025 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20250915154125

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:	22	CENSUS: 18	DATE:	09/24/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Stephanie Griffiths, Care Staff		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility refusing to let resident return back home

INVESTIGATION FINDINGS:

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On 9/24/25 at 2:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Stephanie Griffiths, Care Staff Facility Manager and explained the purpose of the visit.

During the course of the investigation LPA interviewed W1, S1 and reviewed R1's file.

Review of R1's file revealed that R1 has lived at the facility since 10/23/24. R1 is conserved by Alameda County and has been for over 5 years. S1 stated that R1's County Case Manager does not give permission for R1 to leave the facility with W1.

This agency has investigated the above complaint. 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:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2025

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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