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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200723
Report Date: 03/20/2024
Date Signed: 03/20/2024 12:35:53 PM

Substantiated


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
02/21/2024 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240221152541
FACILITY NAME:KIMBILIOFACILITY NUMBER:
019200723
ADMINISTRATOR:ALANNA SPENCERFACILITY TYPE:
772
ADDRESS:1480 159TH STREETTELEPHONE:
(510) 200-9134
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 8DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Ibrahim KamaraTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Fire alarms are not compliant with Fire Department requirement.
INVESTIGATION FINDINGS:
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This report is an amended copy of report issued on 2/21/2024.

On 2/21/2024, LPA Luisa Fontanilla arrived unannounced to conduct investigation on the above allegation. LPA met with Interim Administrator Ibrahim Kamara and explained the purpose of the visit.

On 3/20/2024, LPA spoke with the Alameda Fire Inspector and was told that the facility's fire alarm system currently works on a speed that does not meet requirements and needs to be upgraded. The inspector added that the facility was required to have the fire alarm company submit to the FD plan on how to address the issue but has not received anything as of this date. The facility is currently doing hourly fire watch as instructed by the FD until the fire alarm has been upgraded.

The above allegation is substantiated and deficiency is cited per Title 22 California Code of Regulations.
Exit interview was conducted with Kamara and Appeal Rights was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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-20240221152541
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2024
Section Cited
CCR
81020(a)
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81020 Fire Clearance
(a) A social rehabilitation facility shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal
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The facility will get the fire alarm system upgraded per local FD requirement and notify CCL by POC date.
Civil penalty of $500 is assessed.
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This requirement is not met as evidenced by: Based on interviews and record reviews conducted, the Alameda FD inspected the facility in 10/ 5/ 2023 and instructed the facility to upgrade fire alarm system immediately as it does not comply with current requirements but facility failed to comply which poses an immediate health and safety risk to clients under 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.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2