107206939-2-4-2025-24-AS-KHOS-DFJJPH-20250408071334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206939
Report Date: NO Visit Data Available
Date Signed: 02/04/2025 09:22:17 AM

Unfounded

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
and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250107095556

FACILITY NAME:	KINGSTON BAY SENIOR LIVING		FACILITY NUMBER:	107206939
ADMINISTRATOR:	ROBERT HUNTLEY		FACILITY TYPE:	740
ADDRESS:	6161 W SPRUCE AVE		TELEPHONE:	(559) 479-4700
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	128	CENSUS: 94	DATE:
		UNANNOUNCED	TIME BEGAN:
MET WITH:	Becky Langdon		TIME COMPLETED:

ALLEGATION(S):

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Staff does not ensure facility has adequate staffing to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the initial complaint investigation. LPA met with and explained the reason for the visit and the allegation with Interim Administrator/Operations Specialist (AD) Becky Langdon.

During this visit, LPA, AD and Wellness Assistant (WA) Francisco Tamayo met to review the staffing calendar for January 2025. Timesheets were reviewed for all all care and medication staff that worked on 1/4/2025. Review of timesheets reveals that the facility provided full staff coverage for all shifts.

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 left with AD, whose signature confirms receipt of these documents.

Unfounded

Estimated Days of Completion:

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE:

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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