019201084-10-4-2023-15-AS-KHOS-CYFMYF-20231212090127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201084
Report Date: 10/04/2023
Date Signed: 10/04/2023 03:52:12 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
09/25/2023 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20230925090821

FACILITY NAME:	OAKMONT OF MARINER POINT		FACILITY NUMBER:	019201084
ADMINISTRATOR:	HAN, MINDY M		FACILITY TYPE:	740
ADDRESS:	2400 MARINER SQUARE DRIVE		TELEPHONE:	(510) 347-5959
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94502
CAPACITY:	80	CENSUS: 50	DATE:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	San Sor, Interim Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility call system is in disrepair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/04/23 at 2:45 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 San Sor, Interim Administrator and explained the purpose of the visit.

During the course of investigation LPA reviewed emails provided by facility staff. Emails document that on 9/20/23 at 6 AM the facility administrator (ADM) became aware that the Phillips Lifeline pendant system was not operational. ADM emailed both the facility maintenance director and the Phillips Lifeline representative for assistance on 9/20/23. Phillips Lifeline technicians inspected the system on 9/21/23 and prepared a quote for the repair of the system. The quote was approved, and the system was repaired on 9/28/23.

During today’s visit LPA observed that the pendant system was operational.

***report continues on LIC9099***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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 2

Control Number 15-AS-20230925090821

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: OAKMONT OF MARINER POINT	FACILITY NUMBER: 019201084
	VISIT DATE: 10/04/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

***report continues from LIC9099***

This agency has investigated the complaint alleging the facility call system is in disrepair. We have found that the complaint was UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2