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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200737
Report Date: 04/22/2025
Date Signed: 04/22/2025 12:13:56 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
04/14/2025 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250414141712
FACILITY NAME:CALIFORNIA MENTOR-MARINEVIEW HOMEFACILITY NUMBER:
019200737
ADMINISTRATOR:JOSEPH GAPASINFACILITY TYPE:
740
ADDRESS:2420 MARINEVIEW DRIVETELEPHONE:
(510) 957-5612
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:4CENSUS: 3DATE:
04/22/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Maehellena HarlanTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff are not properly maintaining laundry devices.
INVESTIGATION FINDINGS:
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On 4/22/2025, at 9:00 AM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPAs identified themselves and stated the purpose of the visit to Nurse Ruth Duffy. Administrator Maehellena Harlan arrived at approximately 9:30 AM.

The complaint alleges that staff are not properly maintaining laundry devices.
The LPAs inspected the clothes washer and verified that mold was growing on the drum and on the rubber washer. The presence of mold verified the validity of the allegation.

The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED.

Deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
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 4
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
04/14/2025 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250414141712

FACILITY NAME:CALIFORNIA MENTOR-MARINEVIEW HOMEFACILITY NUMBER:
019200737
ADMINISTRATOR:JOSEPH GAPASINFACILITY TYPE:
740
ADDRESS:2420 MARINEVIEW DRIVETELEPHONE:
(510) 957-5612
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:4CENSUS: 3DATE:
04/22/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Maehellena HarlanTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Staff does not ensure that an adequate amount of food supply kept in the home.
Staff do not properly clean the home.
INVESTIGATION FINDINGS:
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On 4/22/2025, at 9:00 AM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced at the facility to investigate the allegations above. Upon entry into the facility, the LPAs identified themselves and stated the purpose of the visit to Nurse Ruth Duffy. Administrator Maehellena Harlan arrived at approximately 9:30 AM.

The complaint alleges that staff does not ensure that an adequate amount of food supply kept in the home.
The LPAs inspected the nonperishable and perishable food supplies in the facility and observed that there was more than the required minimum of 2 days of perishable and 7 days of nonperishable food at the facility.

Continued on LIC 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
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 4
Control Number 15-AS-20250414141712
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: 04/22/2025
NARRATIVE
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... Continued from LIC 9099

The complaint alleges that staff do not properly clean the home.
The LPAs inspected the facility and found that the home was properly cleaned.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20250414141712
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: 04/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/23/2025
Section Cited
CCR
87303(g)(1)
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87303 Maintenance and Operation (g) Facilities which have machines and do their own laundry shall: (1) Have ... equipment maintained in good repair.

This requirement was not met as evidenced by:
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The administrator agreed to replace the clothes washer on or before the due date.
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LPAs observed that mold was growing on the drum and on the rubber gasket of the upright clothes washer, which poses an immediate health 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: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4