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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201084
Report Date: 09/10/2026
Date Signed: 09/10/2026 02:47:27 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
07/01/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260701105724
FACILITY NAME:OAKMONT OF MARINER POINTFACILITY NUMBER:
019201084
ADMINISTRATOR:HAN, MINDY MFACILITY TYPE:
740
ADDRESS:2400 MARINER SQUARE DRIVETELEPHONE:
(510) 347-5959
CITY:ALAMEDASTATE: CAZIP CODE:
94502
CAPACITY:80CENSUS: 55DATE:
09/10/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Juan Ferrel, Executive DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not administer residents' medications as prescribed.
INVESTIGATION FINDINGS:
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On 9/10/2026 at 11:00 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint investigation and deliver findings for the allegation above. LPA met with Juan Ferrel, Executive Director and explained the purpose of the visit.

During investigation, LPA obtained and reviewed the resident roster and staff roster. LPA obtained R1's progress notes, LIC602 (Medical Assessment), June and July Mar (Medication Administration Record), Faxes to physician, and current medications list. Additionally, LPA reviewed staff files and call button (showing alert) sheet. LPA conducted interviews with staff and residents.

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

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
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
07/01/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260701105724

FACILITY NAME:OAKMONT OF MARINER POINTFACILITY NUMBER:
019201084
ADMINISTRATOR:HAN, MINDY MFACILITY TYPE:
740
ADDRESS:2400 MARINER SQUARE DRIVETELEPHONE:
(510) 347-5959
CITY:ALAMEDASTATE:CAZIP CODE:
94502
CAPACITY:80CENSUS: 55DATE:
09/10/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Juan Ferrel, Executive DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff do not respond to residents' calls for assistance in a timely manner.
Licensee does not ensure staff have appropriate training.
INVESTIGATION FINDINGS:
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On 9/10/2026 at 11:00 am, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a continued complaint investigation and deliver findings for the allegation above. LPA met with Juan Ferrel, Executive Director and explained the purpose of the visit.

During investigation, LPA obtained and reviewed the resident roster and staff roster. LPA obtained R1's progress notes, LIC602 (Medical Assessment), June and July Mar (Medication Administration Record), Faxes to physician, and current medications list. Additionally, LPA reviewed staff files and call button (showing alert) sheet. LPA conducted interviews with staff and residents.

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

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
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-20260701105724
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: OAKMONT OF MARINER POINT
FACILITY NUMBER: 019201084
VISIT DATE: 09/10/2026
NARRATIVE
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Continued from LIC9099.

Allegation: Staff do not respond to residents' calls for assistance in a timely manner.
Finding: Unsubstantiated

During investigation, LPA visited the facility on 7/7/2026, LPA observed R1 press the call button, but the light did not turn on due to user error. LPA observed R1 press the button a second time and the light turned on. LPA observed a staff member come into R1’s room approximately 5 minutes after to check on R1. On 7/30/2026, LPA observed R4 press their call button and staff responded to the call within approximately 7 minutes. LPA reviewed the call button records and observed that staff have responded to residents’ calls within 10-15 minutes. LPA reviewed the staff schedule and observed there was sufficient staff on duty. Staff interviews stated that they make efforts to respond to residents’ calls for assistance as promptly as possible and provide assistance based on residents’ care needs. Resident interviews stated that occasionally they have to wait for assistance, but overall staff come as soon as they can.

Allegation: Licensee does not ensure staff have appropriate training.


Finding: Unsubstantiated

During record review, LPA reviewed a sample of staff records and identified that staff had up to date and accurate training. Interviews with staff stated that they receive on the job training. Staff stated that they receive in-person and online training.

Based on record review, interviews, and observations conducted, the above allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.


No deficiency cited. Exit Interview conducted and copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20260701105724
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: OAKMONT OF MARINER POINT
FACILITY NUMBER: 019201084
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2026
Section Cited
CCR
87465(a)(4)
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(a) A plan for incidental medical and dental care shall be developed by each facility...: (4) The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
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By POC date, ED agrees to complete an in-service training regarding regulation 87465 and staff will review all MARs and medications to ensure all residents are taking medications accordingly and submit training to CCLD.
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Based on record review and interview, the licensee did not comply with the section cited above in that R1 missed their morning medication which poses a potential 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.
SUPERVISOR'S NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20260701105724
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: OAKMONT OF MARINER POINT
FACILITY NUMBER: 019201084
VISIT DATE: 09/10/2026
NARRATIVE
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Continued from LIC9099-C.

Allegation: Staff did not administer residents' medications as prescribed.
Finding: Substantiated

During investigation, LPA reviewed R1's MAR (Medication Administration Record) and observed that R1 had a prescription for Bumetanide (Bumex) that had an order to take 2 tablets (1MG) by mouth every morning. LPA reviewed the MAR that indicated that the medication was not administered to R1 on 06/26/2026 due to Consonus Pharmacy not receiving the order. R1 stated that staff usually bring the Bumex medication to them in the morning but they do not remember receiving it that day. S1, S2 and S5 stated that R1 did not receive their morning Bumex medication on 6/26/2026. S5 stated that they contacted the pharmacy to put in a "STAT emergency order" and the medication was delivered in the evening on 6/26/2026.

Based on LPA's observation, record review and interviews obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation was found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5