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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200737
Report Date: 02/13/2026
Date Signed: 02/13/2026 12:58:24 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
12/17/2025 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20251217090546
FACILITY NAME:CALIFORNIA MENTOR-MARINEVIEW HOMEFACILITY NUMBER:
019200737
ADMINISTRATOR:HARLAN, MAEHELLENAFACILITY TYPE:
740
ADDRESS:2420 MARINEVIEW DRIVETELEPHONE:
(510) 957-5612
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:4CENSUS: 4DATE:
02/13/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Precious Yepez, Program DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not accompany resident to the ER
INVESTIGATION FINDINGS:
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On 2/13/2026 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Precious Yepez, Program Director and informed her the reason for visit.

During the course of investigation, LPA interviewed four (4) staff members and the Reporting Party (RP). LPA reviewed documents such as (incident reports, Maintenance invoice: heater, LIC602- Medical Assessment, and IPP for R1.)

Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
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 5
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
12/17/2025 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20251217090546

FACILITY NAME:CALIFORNIA MENTOR-MARINEVIEW HOMEFACILITY NUMBER:
019200737
ADMINISTRATOR:HARLAN, MAEHELLENAFACILITY TYPE:
740
ADDRESS:2420 MARINEVIEW DRIVETELEPHONE:
(510) 957-5612
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:4CENSUS: 4DATE:
02/13/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Precious Yepez, Program Director TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff did not ensure the heater was not in disrepair
Staff did not ensure the shower had hot water
Staff did not ensure they were not without electricity
INVESTIGATION FINDINGS:
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On 2/13/2026 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Precious Yepez, Program Director and informed her the reason for visit.

During the course of investigation, LPA interviewed four (4) staff members and the complainant. LPAs reviewed documents such as (incident reports, Maintenance invoice: heater, LIC602- Medical Assessment, and IPP for R1.)

Continued on LIC9099-C.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20251217090546
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: CALIFORNIA MENTOR-MARINEVIEW HOME
FACILITY NUMBER: 019200737
VISIT DATE: 02/13/2026
NARRATIVE
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Continued from LIC9099.

Allegation: Staff did not ensure the heater was not in disrepair
Finding: Unsubstantiated

Interview with staff revealed that the heater was working on and off around 12/4/2025 but the staff provided residents with space heaters. Interview with staff revealed that the breaker got fixed on 12/7/2025. LPA observed that the heater was functional and working during visit.

Allegation: Staff did not ensure the shower had hot water
Finding: Unsubstantiated

Interview with staff revealed that the facility has two showers. S1 stated that the second shower has warm water but it takes time to warm up. S1's interview revealed that the residents use the first shower since the water does not take long to warm up but both showers have warm water. Interview with staff revealed that no residents missed any of their shower times.

Allegation: Staff did not ensure they were not without electricity
Finding: Unsubstantiated

Interview with staff revealed that the facility's electricity went out for about an hour and a half on 12/6/2025. LPA observed that the facility has a generator. Interviews with staff revealed that the entire neighborhood's electricity shut off that day. LPA observed that the facility has emergency flashlights.

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

No deficiencies are being cited on this date.

Exit interview conducted with Precious and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20251217090546
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: CALIFORNIA MENTOR-MARINEVIEW HOME
FACILITY NUMBER: 019200737
VISIT DATE: 02/13/2026
NARRATIVE
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Allegation: Staff did not accompany resident to the ER
Finding: Substantiated

RP stated that R1 did not have a staff to accompany them to the ER and R1 is unable to advocate for themselves. A review of R1's IPP (Individual Program Plan) indicated that R1 would need direct assistance in an emergency, as R1 is Deaf and nonverbal. R1's IPP also states that R1 would not be able to communicate with emergency personnel on their own. Interview with staff revealed that there was not adequate staff available to go with R1 to the hospital at the time.

Based on LPAs information obtained during investigation, 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 LIC9099D.

Exit interview was conducted with Precious and Appeal Rights was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20251217090546
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: CALIFORNIA MENTOR-MARINEVIEW HOME
FACILITY NUMBER: 019200737
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...
This requirement was not met as evidence by:
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By POC date, the administrator agrees to implement a plan that ensures there are enough staff on shift in case of an emergency and send the plan to CCLD.
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Based on interview the Licensee did not comply with the section cited above in that the facility did ensure that there was staff sufficient in numbers to accommodate R1's emergency needs which poses a potential 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.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5