079200623-4-7-2022-15-AS-KHOS-CKBKX3-20221018081651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200623
Report Date: 04/07/2022
Date Signed: 04/07/2022 03:31:45 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
04/04/2022 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20220404135429

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: 152	DATE:	04/07/2022
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	MICHELA CIANCIOSI, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility has an outbreak of Norovirus
Facility kitchen is dirty & staff bathroom is dirty
Staff do not wash their hands

INVESTIGATION FINDINGS:

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On 4/7/2022 at 9:35 AM, Licensing Program Analysts (LPAs) L. Ibo and K. Nguyen arrived unannounced to conduct a complaint investigation and to deliver complaint findings for the above allegations. LPAs met with Executive Director, Michela Cianciosi and explained the purpose of the visit.

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

Allegation: Facility has an outbreak of Norovirus
Based on the information gathered, the facility recently had 20 cases Gastro intestinal symptoms outbreak from the last week of March to first week of April, however there is no laboratory confirmed Norovirus. Although there was no laboratory confirmed virus, facility Administrator reported the case to local public health on 3/25/2022 and licensing was also informed on the same day.
...Continue to LIC9099...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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-20220404135429

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: 04/07/2022

NARRATIVE

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Infection control outbreak intervention was activated as soon as local public health was informed. Facility started the following infection control practice given by local public health office; dining was closed for disinfection process, admission for new residents was temporarily stop, staff started to monitor all residents for gastrointestinal/norovirus signs and symptoms. On March 26,2022, family and staff were informed about possible gastrointestinal outbreak. Based on interview from staff and residents, meals were delivered to all residents’ apartment until public health cleared the facility from Gastrointestinal/ Norovirus outbreak. Based on records review local public health cleared facility from the outbreak starting on April 6,2022.

Allegation: Facility kitchen is dirty & staff bathroom is dirty
Based on information obtained, LPAs observed that staff bathrooms are neat, organized and no foul smell. Based on interview staff clean and disinfect bathrooms at least 2-3x a day. Common bathrooms and common rooms such as activity room, library and lobbies are being monitored by specific staff to ensure the cleanliness of the areas. Based on the observation, interview and records review, kitchen staff has a daily cleaning and disinfectant log that the staff follows. LPAs observed that staff was disinfecting dining tables and chairs after the resident use it. LPAs observe kitchen and dining room was clean, organized and no foul smell during the visit.

Allegation: Staff do not wash their hands
Based on information gathered, facility conducts hand washing training for all staff before they start working, based on interview, facility management also include hand washing training whenever there is staff meeting. LPAs observed hand washing poster at the common areas such as but not limited to, common bathrooms, kitchen sinks and hallways. Staff that was interviewed also stated that they frequently wash their hands to ensure safety of staff and residents.

Although the allegations 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 allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC9099 (FAS) - (06/04)

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