079200623-3-2-2022-15-AS-KHOS-CE5KLJ-20220505080002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200623
Report Date: 03/02/2022
Date Signed: 03/02/2022 02:05:39 PM

Unsubstantiated

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
06/19/2020 and conducted by Evaluator Lizette Francisco

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200619100424

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:	DATE:	03/02/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Michela Cianciosi, Executive Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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-Facility did not have a qualified Director
-Facility staff handled resident in a rough manner
-Facility staff is not serving a good quality of food

INVESTIGATION FINDINGS:

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On 3/2/2022 at 12:40 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to deliver findings for the above allegations. LPA met with Executive Director, Michela Cianciosi and explained the purpose of the visit.

During the course of the investigation, LPA obtained information, collected documents, interviewed residents and staff.

Allegation: Facility does not have a qualified director

LPA reviewed Director’s qualification and it meets Title 22 Regulation, 87405 under Administrator – Qualification and Duties.

REPORT CONTINUES ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20200619100424

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: KENSINGTON, THE	FACILITY NUMBER: 079200623
	VISIT DATE: 03/02/2022

NARRATIVE

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Allegation: Facility staff handled resident in a rough manor.

LPA interviewed 8 residents and 8 of 8 residents stated they were not handled by staff in a rough manner. LPA was unable to obtain additional information from R1. 5 of 5 staff stated they have not handled residents in a rough manner.

Allegation: Facility staff is not serving a good quality of food

Even though 2 of 8 residents expressed that the food is “okay”, 6 of 8 residents stated they’re satisfied with the quality.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022

LIC9099 (FAS) - (06/04)

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