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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201180
Report Date: 02/20/2025
Date Signed: 02/20/2025 01:02:33 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
02/18/2025 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250218133433
FACILITY NAME:KRISTA & KRIS CORPORATIONFACILITY NUMBER:
019201180
ADMINISTRATOR:ALFONSO, AMELIAFACILITY TYPE:
735
ADDRESS:5541 ROOSEVELT PLACETELEPHONE:
(650) 255-9603
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:6CENSUS: DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Amelia Alfonso, AdministratorTIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff not providing food in the quantity necessary
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/20/2025 at 09:45 AM, Licensing Program Analysts (LPAs) L. Holmes and P. Manalo arrived unannounced to conduct a 10-day complaint investigation and delivered the finding for the above allegation. LPAs were greeted by Care Staff and Amelia Alfonso, Administrator was contacted by phone and explained the purpose of this visit. Administrator arrived around 11:45 AM.

During the course of the investigation, LPAs conducted a tour of the facility and obtained a Client and Staff roster. LPAs interviewed Staff (S1, S2, S3) and Clients (C2, C3).

Allegation:Facility staff not providing food in the quantity necessary
C1 reported that the facility was running out of food and S1 needs to go to the store. LPA P. Manalo interviewed C3; C3 stated that he/she was eating breakfast, would like pudding but hadn't had it in a long time. S2 prepared lunch for C1 but there weren’t a variety of snacks such as chips, fruit roll-ups, or nuts available to pack or send in C1’s lunch to the day program.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 3
Control Number 15-AS-20250218133433
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: KRISTA & KRIS CORPORATION
FACILITY NUMBER: 019201180
VISIT DATE: 02/20/2025
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
Continued from LIC9099C...

During the visit, LPAs observed a variety of drink and snacks that were provided to Client #4 (C4) by his/her mother. S1 stated that there was food stored in the cabinet in the garage and that clients do not like to eat fruits, and vegetables, C1 is allergic to fruits. LPAs observed Staff #4 (S4) arrive at the facility and retrieve a key from the vault that gave on site staff access to additional food stored in the garage. S2 and S3 stated that the food stored in the garage is emergency food, remains locked, and they did not have the key or access to the key. LPAs did not observe a sufficient variety and quantity of necessary foods to meet the needs of five (5) clients in care.

Deficiency was observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview was conducted with care staff, a copy of this report and appeal rights provided to Amelia Alfonso, Administrator.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250218133433
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: KRISTA & KRIS CORPORATION
FACILITY NUMBER: 019201180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
CCR
80076(a)(1)(A)
1
2
3
4
5
6
7
80076 Food Services (a) In facilities providing meals to clients, the following shall apply: (1)...quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended...-This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator/Licensee to self certify and provide signatures that all staff have read the regulation, submit receipts and photos of sufficient food supply by POC.
8
9
10
11
12
13
14
Based on observation, the Administrator/ Licensee did not comply with the section cited above by not maintaining a sufficient quality and quantity food supply in the facility for five clients which poses/posed a potential health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3