<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200723
Report Date: 03/14/2023
Date Signed: 03/14/2023 01:41:10 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
12/14/2020 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20201214132135
FACILITY NAME:KIMBILIOFACILITY NUMBER:
019200723
ADMINISTRATOR:HENDERSON, JASONFACILITY TYPE:
772
ADDRESS:1480 159TH STREETTELEPHONE:
(510) 301-5809
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 8DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jonathan Haskins, Case ManagerTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal rights- Clients are using methamphetamines in the facility
Personal rights- Facility staff do not prevent clients from smoking in the facility
Personal rights- Facility is accepting clients without a medical assessment
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/14/2023 at 1:00 p.m. Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced visit to deliver the findings for the above complaint allegations. LPA met with Jonathan Haskins, Case Manager (CM) and explained the purpose of the visit. LPA asked CM to contact Administrator Alanna Spencer, and got verbal permission to deliver finding to Jonathan Haskins, due to Alanna can not be present at the time.

Clients are using methamphetamines in the facility:
On 12/16/20 the Department interviewed the Reporting Party (RP) who stated that the facility does not prevent drugs from entering the facility and do not stop residents from using drugs in the facility. On 2/13/21, 2/16/21 and 3/3/21, the Department interviewed staff persons S3, S4, S5 who all denied that residents were being allowed to enter the facility and consume methamphetamines and/or drugs. They reported that random checks are performed daily, including that of the rooms if there is suspicion of drug use; they further reported that if found, the substances are destroyed or removed from the physical plant. On 3/3/21, the Department interviewed resident C5 (resident from the subject time period), who stated having no knowledge of drug usage in the facility and confirmed that staff perform checks of the residents and rooms.

Report continue on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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 3
Control Number 15-AS-20201214132135
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: KIMBILIO
FACILITY NUMBER: 019200723
VISIT DATE: 03/14/2023
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
On 12/16/22, the Department interviewed staff persons S1, S2, and S3, who denied that drug usage is allowed to take place in the facility and that any found substances are confiscated and the incident/s reported to the Administrator; on this same date, the Department reviewed the resident files, and no information was observed to indicate that there had been drug usage during the subject time period. On 12/16/22 and 1/23/23, the Department attempted to reach former residents (from the subject time period), C3, C4, and C5. It was not possible to reach these individuals.

Based upon records review, interviews conducted, and observations made, the Department has investigated the above allegation and found that it is Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Facility staff do not prevent clients from smoking in the facility:
On 12/16/22 the Department interviewed the RP, who provided no information pertaining to residents smoking in the facility; on 3/3/21, the Department again interviewed the RP and again, no examples of residents smoking inside the facility were provided. On 3/3/21 the Department interviewed S3 who reported that cigarette smoking is not allowed inside of the facility, and is only allowed in the backyard; on this same day, the Department also spoke with staff person S5 who stated that it was the RP that had a history of being caught smoking in the facility and that this was reported by staff person S2. On 3/3/21 the Department interviewed C5 (resident during the subject time period), who reported that residents are allowed to smoke in the backyard, but will sometimes do so in the front yard. On 12/16/22 the Department interviewed staff persons S1, S2, and S3, who denied that clients are allowed to smoke inside of the facility and that if caught, the incident/s are reported to the case managers and responsible parties – for possible termination. On 12/16/22 and 1/23/23 the Department attempted to speak to former residents (from the subject time period), C3, C4, and C5. It was not possible to reach these individuals.

Report continue on LIC 9099C...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20201214132135
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: KIMBILIO
FACILITY NUMBER: 019200723
VISIT DATE: 03/14/2023
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
Based upon records review, interviews conducted, and observations made, the Department has investigated the above allegation and found that it is Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Facility is accepting clients without a medical assessment:
On 12/16/20 and 3/3/21 the Department interviewed the RP, who provided no information pertaining to clients being admitted without a Physician’s Assessment. On 12/16/22, the Department reviewed the files for all clients from the subject time period (C6, C7, C8, C9, C10, and C11) and found that each had a Physician’s Assessment dated within 1 year of their admission.


Based upon records review, interviews conducted, and observations made, the Department has investigated the above allegations and found that they are Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3