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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200623
Report Date: 06/12/2023
Date Signed: 06/12/2023 07:36:07 PM


Document Has Been Signed on 06/12/2023 07:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:KENSINGTON, THEFACILITY NUMBER:
079200623
ADMINISTRATOR:MICHELA CIANCIOSIFACILITY TYPE:
740
ADDRESS:1580 GEARY RDTELEPHONE:
(925) 943-1121
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:200CENSUS: DATE:
06/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:26 PM
MET WITH:Deborah Bradley, Assistant Executive DirectorTIME COMPLETED:
05:00 PM
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On 06/12/23 Licensing Program Analyst (LPA) L. Alexander conducted a Case Management to regarding Unusual Incident Report that was reported to Licensing on 05/15/23 regarding theft. LPA met with Assistant Executive Director (AED), Deborah Bradley, and explained purpose of the visit.

AED says that initial guest filed a police report and that she has been requesting a copy of the report but have not received the police report yet. However, within the past week there has been a rash of theft at the facility. Four other residents have reported to the AED that someone has come into their apartments and stole items. The AED has been in contact with the family members. Out of the 4 residents, 3 residents have their door locked and 1 resident had their door unlocked because it is hard to turn the key. One resident had a United States Coin Collection in which the last time they saw the collection was last week Wednesday 06/07/23. The resident was planning to take the coins to a "coin show" and noticed the coins missing yesterday.

LPA counseled AED to conduct an internal investigation, check/update Personal Items List and verify what items the residents had and are now missing.

Copy of case management report given to Assistant Executive Director.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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