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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201241
Report Date: 07/24/2023
Date Signed: 07/24/2023 06:50:48 PM


Document Has Been Signed on 07/24/2023 06:50 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 AT WALNUT CREEK, THEFACILITY NUMBER:
079201241
ADMINISTRATOR:BRADLEY, DEBORAHFACILITY TYPE:
740
ADDRESS:1580 GEARY ROADTELEPHONE:
(925) 973-1121
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:200CENSUS: 148DATE:
07/24/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Deborah Bradley, Interim Executive DirectorTIME COMPLETED:
04:00 PM
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On 07/24/2023 at 11:30am, Licensing Program Analysts (LPAs) L. Alexander and L. Hall conducted an unannounced pre-licensing inspection (facility is in operation and changing ownership). LPAs met with Interim Executive Director (ED), Deborah Bradley, and explained the purpose of the visit. The facility has an approved fire safety clearance for 200 non-ambulatory residents.

LPAs inspected the 8 building facility with the ED inside and out including but not limited to apartments, shared bathrooms, common living areas, activity rooms, restaurant style dining area, library, bistro, fitness room, outside areas, and kitchen for assisted living and memory care. There were no bodies of water present during inspection. There is sufficient lighting around the facility. Residents’ rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with non-skid mats. Passageways and hallways are free of obstruction. Facility has 2 medication rooms that remain locked to store medications. Room temperature was maintained at 68, 67, 73 and 72 degrees Fahrenheit downstairs and 77 degrees Fahrenheit upstairs. The hot water temperatures measured at 116.1 and 101.8 degrees Fahrenheit in assisted living area. Concurrently, the hot water temperatures measured at 97.8 in a shared bathroom and 97.3 staff restroom in the memory care unit. Fire extinguishers were last serviced on 01/26/2023. There is a minimum of 7-day non-perishables and 2-day perishables foods. Deliveries are conducted once a week with the various food vendors and suppliers. First Aid kits were complete. Carbon monoxide and smoke detectors were operable.

LIC809-C Continued...
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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 AT WALNUT CREEK, THE
FACILITY NUMBER: 079201241
VISIT DATE: 07/24/2023
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LIC809 Continued...

LPAs reviewed ten (10) staff files and ten (10) resident files.



No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC809 (FAS) - (06/04)
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