<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206939
Report Date: 07/18/2025
Date Signed: 07/23/2025 03:02:44 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, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2025 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250320121934
FACILITY NAME:KINGSTON BAY SENIOR LIVINGFACILITY NUMBER:
107206939
ADMINISTRATOR:DENNIS, SARAHFACILITY TYPE:
740
ADDRESS:6161 W SPRUCE AVETELEPHONE:
(559) 479-4700
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:128CENSUS: 90DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sarah DennisTIME COMPLETED:
06:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not meeting resident toileting needs
Facility staff do not respond to residents call buttons in timely manner
Facility staff are not dispensing medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct a subsequent visit and derived complaint findings. LPA met with and explained the reason for the visit with Assistant Director of Nursing (ADON) Frankie Tamayo. Administrator (AD) Sarah Dennis arrived a short time later.

During this visit, LPA conducted interviews, and reviewed Resident (R1's) medications.

This Department investigated the following allegations:

Facility staff are not meeting resident toileting needs: A record review was conducted of R1's file. Service Plan dated 3/27/25 which states R1 is independent with toileting, no assistance needed by staff. Physician Report dated 11/2024 - able to care for own toileting needs and transfers self. Per staff interview, staff assist R1 with the bedtime routine and may help with a nighttime brief.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 24-AS-20250320121934
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: KINGSTON BAY SENIOR LIVING
FACILITY NUMBER: 107206939
VISIT DATE: 07/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2 - Continued
This Department investigated the following allegations:

Facility staff do not respond to residents call buttons in timely manner: Multiple residents were interviewed and report that the wait times after pushing the pendent button are too long. Residents also say that care staff enter the rooms, clear the pendent and leave again saying they will return soon. A report was obtained of R1's pendent report for 3/17/25. R1 pressed the pendent once at 6:03am and it was cleared within the hour.

Facility staff are not dispensing medication as prescribed: A review was conducted of R1's medications as well as an audit of the facility documentation of the Medication Administration Record (MAR) of February 2025. Family takes R1 home for days at a time, when this happens medications are checked out from the facility, given at home and brought back after the visit. The facility MAR indicates when R1 is out of the facility. Additionally, interview reveals that the MAR does not record the actual time the Med Tech (MT) gives medications to R1, the system only records the time the records in the computer.

Based on interviews and record reviews the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur.

There were no citations issued.

An exit interview was conducted and a copy of this report was provided to AD.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2025 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250320121934

FACILITY NAME:KINGSTON BAY SENIOR LIVINGFACILITY NUMBER:
107206939
ADMINISTRATOR:DENNIS, SARAHFACILITY TYPE:
740
ADDRESS:6161 W SPRUCE AVETELEPHONE:
(559) 479-4700
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:128CENSUS: 90DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sarah DennisTIME COMPLETED:
06:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff does not provide residents with timely meals
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct a subsequent visit and derived complaint findings. LPA met with and explained the reason for the visit with Assistant Director of Nursing (ADON) Frankie Tamayo. Administrator (AD) Sarah Dennis arrived a short time later.

Facility staff does not provide residents with timely meals: Multiple staff were interviewed with consistent reporting - that R1 eats meals in the dining room. Additionally, staff state, if R1 wants to dine in the apartment, a tray would be delivered as requested. Per Service Plan dated 3/27/25 R1 is independent and requires no assistance from staff with meals. During the interview, R1 reported enjoying preparing food in the apartment as well. There was no documentation discovered that R1 has meals delivered or concern about the timing of meals.

This Agency has investigated the allegation listed above. We have found that the allegation is UNFOUNDED, therefore we have dismissed the allegation.
There were no citations issued. An exit interview was conducted and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3