019200723-7-31-2024-15-AS-HHUL-D7VVFW-20240806162438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200723
Report Date: 07/31/2024
Date Signed: 07/31/2024 10:20:32 AM

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
07/17/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20230717134440

FACILITY NAME:	KIMBILIO		FACILITY NUMBER:	019200723
ADMINISTRATOR:	ALANNA SPENCER		FACILITY TYPE:	772
ADDRESS:	1480 159TH STREET		TELEPHONE:	(510) 200-9134
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94578
CAPACITY:	14	CENSUS: 7	DATE:	07/31/2024
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Jonathan Haskins Case manager		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff failed to seek medical attention for resident in a timely manner
Staff failed to provide adequate food service
Facility is in disrepair
Residents are being neglected while in care

INVESTIGATION FINDINGS:

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On July 31, 2024 at 9:15 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to deliver findings on the above allegation. LPA met Facility staff Jonathan Haskins and explained the reason for the visit. Administrator Reine DeCiel was called and designated Jonathan Haskins to sign off on the report.

During the course of the investigation, LPA J. Clancy-Czuleger interviewed staff and residents.

On the allegation: Staff failed to seek medical attention for resident in a timely manner.
Based on record review and interviews the facility staff did a check on the client that was found on the ground and confirmed that it was a choice to lie on the ground and was not a medical situation. LPA confirmed that the client did not have a seizure condition and was not on any medications that caused seizures.

Continued on LIC 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230717134440

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: 07/31/2024

NARRATIVE

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...Continued from LIC-9099
On the allegation: Residents are being neglected while in care.
Based on records review and interviews the clients they felt that eating leftovers and not having access to hygiene supplies was neglectful. They felt that they were not being listed to when requesting meals and products. In interviews with staff, they stated that they do their best to listen to meal requests, but they are also not going to waste food that is already made just because some of the residents don’t want to eat the same thing two days in a row. S1 stated and hygiene supplies are available upon request razors are “checked out” and returned to staff after each use. S1 explained that they stopped buying the liquid bodywash and switched to bared soap after the found that the residents were wasting the products by overusing or pouring them down the drain.

On the allegation: staff failed to provide adequate food service.

Based on recorded reviews and interviews the facility had one refrigerator for up to 14 clients with some of the clients wanting space in the fridge for their personal food. They have since purchased an additional freezer to mitigate the food storage issue.

On the allegation: Facility is in disrepair.

Based on an interview with staff (S2), S2 stated that the facility has regular maintenance that comes to the facility to keep on top of the repairs that are needed. They are currently using one of the empty rooms to repair some broken furniture including a dresser and a bedframe.

Based on the investigation, above allegations are deemed Unsubstantiated.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

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