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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 07:37:42 PM


Document Has Been Signed on 06/12/2023 07:37 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:
05:00 PM
MET WITH:Deborah Bradley, Assistant Executive DirectorTIME COMPLETED:
07:45 PM
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On 06/12/2023 Licensing Program Analyst (LPA) L. Alexander conducted a Case Management to regarding Unusual Incident Report that was reported to Licensing regarding an incident between 2 residents. LPA met with Assistant Executive Director (AED), Deborah Bradley, and explained purpose of the visit.

LPA interviewed AED and it was discussed that R1 reported back in January 2023 that R2 entered her bedroom. R2 came into R1's apartment and said "I'm upset and don't want to be alone." It was further described that R2 laid on R1's bed, while R1 laid on the sofa.

AED says on 05/31/23, the residents went out to dinner at the Dead Fish. R1 and R2 was sitting across from each other at the table. R1 stood up and alleges that R2 "this man tried to rape me!" The Activity Director (AD), Kayla Pierce (AD), witnessed everything and that everyone had been drinking wine and acting "unruly."

At 5:46PM, LPA interviewed R1 via phone because resident was currently being isolated because they had tested positive with Covid. R1 says that the incident happened back in January one evening when she heard her door unlocked from the outside. R2 walked in her apartment, she smelt liquor and that R2 laid down on her bed. R2 took off his blue silk shorts and said "come on in and join me." R1 says that she had a couple of drinks that night and tried laying down on the sofa, but went and laid on the other side of the bed. R1 says that R2 was "rubbing on my ankles," and she screamed at him. R2 stopped and left the room.
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, THE
FACILITY NUMBER: 079200623
VISIT DATE: 06/12/2023
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At 6:00PM LPA interviewed R2 regarding this incident. R2 says that he was given a key when he first moved to Kensington and this key just happened to fit all the room doors. R2 says that he nevered went out and made keys. Anyways, he had heard that there was some noise, so he went to check the noise out. This particular eveing, everyone had been drinking. He went to R1's apartment and the door was opened so he walked in the apartment. R2 says that he went to the bathroom, not knowing if R1 was actually in the apartment because it was dark. R2 was dizzy and felt like he was going to pass out. So, he laid on the edge of the bed with all his clothes on. R2 says that he did not touch R1. The room was dark and the only light was in the bathroom. R2 says if he touched R1 he doesn't remember and it was dark in the room. R2 says that when R1 screamed, he left out the room. R2 says about 3 weeks ago approximately 15-20 of the residents went out to dinner. R2 says that he tries to avoid R1 but this evening they just happened to be sitting across from each other. R2 wanted to say to R1, "lets just call this out and be friends." But R1 stood up and yelled "you raped me!" R2 says, "I'm not that type of person," and that he wanted to apologize because this situation has "gone on too long." Meanwhile, R2 says that he doesn't have any interaction with R1. There has been no resolution. He felt that the situation could've been handled differently and would like to move on.

Copy of Case Management given to AED.
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
LIC809 (FAS) - (06/04)
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