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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200695
Report Date: 03/12/2026
Date Signed: 03/12/2026 04:07:08 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
01/28/2026 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20260128143228
FACILITY NAME:GOOD SHEPHERD VISTAFACILITY NUMBER:
019200695
ADMINISTRATOR:KOO, HASMINFACILITY TYPE:
740
ADDRESS:5472 FOOTHILL BLVDTELEPHONE:
(510) 534-5734
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:26CENSUS: 21DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Stephanie Griffiths, Caregiver/Lead StaffTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff do not allow resident's husband to visit.
Staff are neglecting resident
INVESTIGATION FINDINGS:
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On 3/12/2026 at 3:00PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegations above. LPA met with Caregiver/Lead Staff, Stephanie Griffiths and explained the purpose of the visit.

During the investigation, LPA interviewed 4 residents, 1 staff, 3 witnesses, and complainant. LPA reviewed and obtained documents including LIC500, physician's report, care plan, house rules, conservatorship documents, court order documents, and emergency information.

Staff do not allow resident's husband to visit.
LPA observed there is a court order granting R1's conservator the power to deny and/or limit visitations. Interview with W1 revealed that visitation for R1's husband was halted around January of 2026 for safety concerns as R1 had a choking incident from food brought by R1's husband. According to R1's physician's report, R1 is on a pureed diet. (Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
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-20260128143228
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: GOOD SHEPHERD VISTA
FACILITY NUMBER: 019200695
VISIT DATE: 03/12/2026
NARRATIVE
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Staff are neglecting resident
Interview with residents revealed that staff are available when residents needs assistance. Interview with S1 indicated there are 3 caregivers in the AM shift, 2 caregivers in the PM shift, and 1 awake staff for night shift. S1 stated that AM and PM shifts overlaps and there are live-in caregivers on call for night shift. Interview with witnesses revealed that R1 has an outpatient team and home health nurse to assist R1 with medical and dental needs.

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

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2