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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079200623
Report Date:
03/28/2022
Date Signed:
03/28/2022 11:46:57 AM
Document Has Been Signed on
03/28/2022 11:46 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
KENSINGTON, THE
FACILITY NUMBER:
079200623
ADMINISTRATOR:
MICHELA CIANCIOSI
FACILITY TYPE:
740
ADDRESS:
1580 GEARY RD
TELEPHONE:
(925) 943-1121
CITY:
WALNUT CREEK
STATE:
CA
ZIP CODE:
94597
CAPACITY:
200
CENSUS:
153
DATE:
03/28/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
MICHELA CIANCIOSI
TIME COMPLETED:
12:30 PM
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On 3/28/2022 Licensing Program Analyst (LPA) L. Ibo conducted a Case Management to deliver amended report. LPA met with Administrator MICHELA CIANCIOSI and explained purpose of the visit.
Copy of case management report and amended report was provided to Administrator.
SUPERVISOR'S NAME:
Harpreet Humpal
TELEPHONE:
(510) 285-3928
LICENSING EVALUATOR NAME:
Leslie Ibo
TELEPHONE:
510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE:
03/28/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/28/2022
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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