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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201433
Report Date: 06/15/2026
Date Signed: 06/15/2026 11:43:51 AM

Unsubstantiated


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
06/03/2026 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20260603101250
FACILITY NAME:GRAND LAKE VISTAFACILITY NUMBER:
019201433
ADMINISTRATOR:KOO, HASMINFACILITY TYPE:
740
ADDRESS:365 STATEN AVENUETELEPHONE:
(408) 202-2236
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:15CENSUS: 11DATE:
06/15/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Hasmin KooTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff allowed individuals to harm resident in care

Staff engaged in punitive actions by intentionally restricting residents’ access to leisure activities
INVESTIGATION FINDINGS:
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On 06/15/2026 at 10:00 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver findings) regarding the allegations above. LPA met with Administrator Hasmin Koo and explained the purpose of the visit.

During the course of the investigation, LPA interviewed four (4) residents, one (S1) staff, and obtained copies of three (3) residents Identification and Emergency form, Physician’s Reports and the Appraisal Needs and Services Plan for three (3 residents.

Allegation: Staff allowed individuals to harm resident in care

Investigation Findings: It was reported to the department that that the owner hired men to attack a resident by the lake causing the resident to lose some belongings. R1 stated that the owner is out to get R1 due to R1’s strict religious background, and has everyone tricked into doing the owner’s biding.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
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 2
Control Number 15-AS-20260603101250
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: GRAND LAKE VISTA
FACILITY NUMBER: 019201433
VISIT DATE: 06/15/2026
NARRATIVE
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Continued from LIC9099

R1 stated that these incidents happened outside of the facility and with no witnesses. R1 stated the first time it was a man that walked in R1’s direction and upon seeing R1, took out his penis and showed it to R1, R1 stated R1 walked away. The second event was a pair of men’s jeans and shoes by the mailbox R1 uses to mail letters. R1 did not call the police nor report the incidents to anyone, as R1 stated no physical harm had happened. LPA spoke with R1 regarding the events. R1 informed LPA that the events are well documented on an unnamed website, and that the owner has admitted to orchestrating the events and other atrocities on this website. R1 could not provide the websites address stating that the LPA is not part of the group. LPA reviewed R1’s Physician’s Report, R1 is diagnosed with schizophrenia. R1 confirmed R1 has not been taking medications but continues to see a psychiatrist once a month. LPA asked R1 about this, R1 stated R1 stopped taking the medication as they limit R1’s psychic abilities. R1 admitted to LPA that R1 may have some delusions and refuses to take medication as the medications close the psychic link allowing R1 to read the owner’s mind. S1 informed LPA that these delusions and allegations have elevated a bit over the last six months, and R1’s psychiatrist has tried to get R1 to take R1’s medications. Staff are working to keep R1 safe and comfortable and monitor R1’s behavior. RP also reported suspicions of R1 having some delusions. Based on interviews conducted, file review and LPA’s observations the above allegation is UNSUBSTANTIATED.

Allegation: Staff engaged in punitive actions by intentionally restricting residents’ access to leisure activities

Investigation Findings: It was reported to the department that residents used to watch classic movies at the facility and that that was taken away by the owner to spite R1. R1 reported the televisions channel Turner Classic Movies (TMC) was available in the living room for resident to watch and that R1 used to watch movies in the evenings, however the owner got upset with R1 and removed the channel. R1 reported that R1 only checked the one time and refused to ask staff for assistance when R1 could not locate it. R1 stated R1 has not used the television since the incident as R1 does not trust the owner and felt that that night, the owner was doing it on purpose. S1 stated S1 did not know about the incident as no one mentioned anything to S1. LPA turned on the television and searched for channel TMC. LPA confirmed the channel is still available. Based on LPA’s observations the above allegation is UNSUBSTANTIATED.

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

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC9099 (FAS) - (06/04)
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