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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200723
Report Date: 03/07/2025
Date Signed: 03/21/2025 10:06:48 AM

Substantiated


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
01/27/2025 and conducted by Evaluator Patricia Manalo
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250127115517
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: 5DATE:
03/07/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dr. Frank Robinson TIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff do ensure the facility is in good repair
Staff do not ensure the correct temperature for hot water is maintained
INVESTIGATION FINDINGS:
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On this day at around 9:00 AM, Licensing Program Analysts (LPAs) Patricia Manalo and Luisa Fontanilla arrived unannounced to deliver finding for the above allegations. LPAs met with Trasha Robinson and explained the purpose of the visit.

During the course of investigation, LPAs conducted interviews and record reviews.

On January 14, 2025, LPAs conducted the facility's annual required inspection and issued a citation was the handicap door observed not operational. On 02/18/2025, CCLD received the proof of correction showing the door has been fixed. On the same day, the facility was issued a Type A citation for failing to maintain hot water temperature within the range of 105-120 degrees Fahrenheit. The facility has corrected the deficiency.

Continue to LIC9099-C...
*This is an Amended Report issued 03/07/2025*
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
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 5
Control Number 15-AS-20250127115517
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: KIMBILIO
FACILITY NUMBER: 019200723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2025
Section Cited
CCR
81088(e)(1)
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81088(e)(1) Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water.)(1) Hot water temperature controls shall be maintained...of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).
This requirement is not met as evidenced by:
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The Clinical Director states that 1. They will limit staff access to the water heater 2. Create a water temperature log daily for the next two months and send proof to CCLD by POC date.
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Based on observation, the licensee did not comply with the section cited above in having the hot water temperature not within range for two consecutive visits which poses an immediate health and safety risk to persons in 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: 03/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/27/2025 and conducted by Evaluator Patricia Manalo
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250127115517

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: 5DATE:
03/07/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:DR. Frank Starks TIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff do not provide adequate laundry service for the clients
Staff do not have adequate record keeping for the clients
Staff mishandled the clients medications
Staff do not properly store the clients medications
Staff are not being properly trained
INVESTIGATION FINDINGS:
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On this day, LPAs L. Fontanilla and P. Manalo arrived unannounced to deliver finding for the above allegations and met with Dr. Starks.

During the 10-day investigation conducted on 01/29/2025, LPAs observed stove knobs were operational, kitchen cabinets have hinges, stove and hood were clean and free from grease.

On 02/18/2025, LPAs interviewed Staff 1 (S1). S1 states that clients do their own laundry to encourage independence and that the washer and dryer are available for use of the clients. S1 states the clients can wash their clothes on Monday, Wednesday, and Friday from 8am-8pm and sheets, towels on Saturday and Sunday.

Continue to LIC9099-C... *This is an Amended Report issued 03/07/2025*
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250127115517
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: KIMBILIO
FACILITY NUMBER: 019200723
VISIT DATE: 03/07/2025
NARRATIVE
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Continue from LIC9099...

LPAs interviewed 3 of 7 clients. All clients interviewed state that they are able to do their laundry and none has had any issue with laundry. In case the laundry room door is closed, they can ask one of the staff to open for them to wash their clothes.


During the annual inspection conducted on 1/14/2025 and 10-day visit on 1/29/2025. LPAs observed medications were stored in a cabinet next to one of the counseling rooms. S1, who is responsible in passing medications was observed by LPAs unlocking/locking the cabinet door. During the visit, LPAs also reviewed medications and Medication Administration Record (MAR).

On said annual inspection, LPAs reviewed 7 of 7 client files and 3 staff files. LPAs did not observe any unusual concerns with the files reviewed. On 3/3/2025, LPAs reviewed proof of staff training for the months of December 2024, January and February 2025. Trainings were conducted with staff on topics such as Cultural Humility, Communication with Clients/Colleagues, Managing and De-escalating Aggressive Behavior, Understanding, Recognizing and Helping Clients who self-harm, etc. Trainings were conducted by Janet Natale, a Licensed Marriage Family Therapist (LMFT).

Based on interviews and record reviews conducted, the above allegations are 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.

There is no deficiency noted.


SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250127115517
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: KIMBILIO
FACILITY NUMBER: 019200723
VISIT DATE: 03/07/2025
NARRATIVE
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Continue from LIC9099...

On January 29, 2025, LPAs arrived at the facility to conduct 10-day investigation. During the visit, LPAs checked hot water temperature and it measured at 123 Fahrenheit.

The allegation "staff do ensure the facility is in good repair" is substantiated, however, no deficiency is issued. The facility was issued a citation for the same allegation during the annual inspection on 01/14/2025.

Based on observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.

Exit interview was conducted with Starks and Appeal Rights was provided.



*This is an Amended Report issued 03/07/2025*
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5