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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201182
Report Date: 07/22/2025
Date Signed: 07/22/2025 02:53:09 PM

Unsubstantiated


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
07/08/2025 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20250708151026
FACILITY NAME:LAKE PARK SENIOR LIVINGFACILITY NUMBER:
019201182
ADMINISTRATOR:KORFHAGE, KIRSTENFACILITY TYPE:
741
ADDRESS:1850 ALICE STREETTELEPHONE:
(510) 835-5511
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY:275CENSUS: 122DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH: Executive Director Kirsten Korfhage TIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not have sufficient supplies to maintain resident hygiene or meet infection control requirements.
Staff are not adequately trained
Staff are not following reporting requirements
Staff are not evaluating changes in resident's condition as required
Staff do not address pest in the facility
Staff do not provide adequate food service
Staff do not ensure the facility is properly maintained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/22/2025 at 11:00 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver findings for the allegations above. Upon arrival, LPA met with Executive Director, Kirsten Korfhage, and explained the purpose of the vest.

During the course of the investigation, LPA conducted interviews with five (5) staff. LPA obtained and reviewed staff training logs, resident appraisals for five (5) residents, monthly statements from Clark Pest Control, the LIC500, and food service staff shift schedule,

Allegation: Staff do not have sufficient supplies to maintain resident hygiene or meet infection control requirements.

Investigation Finding: Based on staff interviews this allegation is Unsubstantiated. It was reported to the Department that the facility does not have sufficient supplies to maintain resident hygiene or meet infection control requirements.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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-20250708151026
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: LAKE PARK SENIOR LIVING
FACILITY NUMBER: 019201182
VISIT DATE: 07/22/2025
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 LIC9099

During interview with staff, LPA observed sufficient supplies in every department. Each department has a budget and uses Amazon Business to order supplies. Each department head has the task of ordering supplies on a monthly basis for the department he/she oversees. Orders are submitted and later approved by management, then supplies are delivered. If a department were to run low, or out of a supply, other departments will offer supplies until new supplies come in. Department heads also have access to a company credit card for emergency use. As long as staff go through the appropriate channels to order supplies, supplies get approved within a few days.

Allegation: Staff are not adequately trained.

Investigation Finding: Based on file review, training logs and staff interviews, this allegation is Unsubstantiated. Staff are adequately trained and detail logs of training are kept. Monthly all-staff meetings have different training provided. Staff are told in advance of when and what topics are going to be covered. Staff are also trained through Assisted Living Education (ALE) with records and certificates kept.

Allegation: Staff are not following reporting requirements

Investigation Finding: Based on staff interviews, death reports, and Unusual Incident Reports (UIRs) delivered to the department, this allegation is Unsubstantiated. Staff are required and encouraged to report any incidents and deaths to the Executive Director. Executive Director Kirsten Korfhage submits all reports to the department in a timely manner. LPA receives digital copies and the department retains copies.

Allegation: Staff are not evaluating changes in resident's condition as required

Investigation Finding: Based on record review and staff interviews, assessments of residents are being conducted. This allegation is Unsubstantiated. LPA reviewed and obtained copies of assessments for five (5) residents. Each resident had proper assessments. Previous record review from annual inspections also show resident assessments and evaluations were being conducted.

Continued on LIC9099-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250708151026
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: LAKE PARK SENIOR LIVING
FACILITY NUMBER: 019201182
VISIT DATE: 07/22/2025
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 LIC9099-C

Allegation: Staff do not address pest in the facility.

Investigation Finding: Based on observation, staff interviews, and monthly statements form Clark Pest Control, this allegation is Unsubstantiated. LPA observed no signs of mold, rodent droppings or disrepair anywhere in the facility. The kitchen is clear of mold and other pests. Dishes are cleaned in a timely manner after use. Staff have admitted to finding cockroaches however, the facility has a contract with Clark Pest Control and all incidents are dealt with. Clark comes out on a weekly basis and treats any and all sightings of cockroaches reported.

Allegation: Staff do not provide adequate food service.

Investigation Finding: Based on interview with staff and staffing records, this allegation is Unsubstantiated. LPA observed food to be fresh and properly stored. LPA observed that there is sufficient staff for food service S4 reported that meal service may at times get backed up, but meals are still served with as limited delay as manageable.

Allegation: Staff do not ensure the facility is properly maintained.

Investigation Finding: Based on observation, staff interviews and Elevator Modernization Contract, this allegation is Unsubstantiated. LPA observed the Facility to be well maintained, with all areas kept clean, pest and mold free. Elevators have plans for modernization, with set repair dates.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations above do not meet Regulation Requirements are unsubstantiated.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3