107206939-8-25-2026-24-AS-SDOE-DXJUQH-20260902154709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206939
Report Date: 08/25/2026
Date Signed: 08/25/2026 05:33:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
08/25/2025 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250825091006

FACILITY NAME:	KINGSTON BAY SENIOR LIVING		FACILITY NUMBER:	107206939
ADMINISTRATOR:	DENNIS, SARAH		FACILITY TYPE:	740
ADDRESS:	6161 W SPRUCE AVE		TELEPHONE:	(559) 479-4700
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	128	CENSUS: 113	DATE:	08/25/2026
		UNANNOUNCED	TIME BEGAN:	11:32 AM
MET WITH:	Arturo Correea		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff inappropriately interacted in the presence of resident
Staff do not safeguard resident's personal belongings
Staff do not ensure resident's care needs are met
Staff do not report incidents as required

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown conducted a subsequent complaint investigation visit. LPA met with and explained the reason for the visit with Executive Director (ED) Arturo Correa. During this visit, LPA interviewed staff and residents as well as obtained records from staff files.

This Department investigated the allegations listed above: Interview revealed that Staff S1 and S2 were witnessed in Resident (R1's) bedroom engaging in inappropriate physical interaction. S1 and S2 denied the allegations. However, their statements were inconsistent and changed over the course of the investigation. Additional staff members state they were unaware of a relationship between S1 and S2.

Interview reports from Resident (R6), Staff and witnesses are inconsistant in whether R6 lost money, a lettery ticket or multiple lottery tickets. After losing the lottery tickets, R6 reports that a lock was placed on a drawer in the apartment to keep personal belongings such as a purse. R6's Physician Report dated 6/2024 states no Dementia or confusion. Additionally, facility Care Plans document R6 as independent.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Shawna Doucette
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

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 24-AS-20250825091006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KINGSTON BAY SENIOR LIVING	FACILITY NUMBER: 107206939
	VISIT DATE: 08/25/2026

NARRATIVE

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Continuation - page 2

Based on record review of Physician Reports and facility Care Plans, the residents identified do not all require the level of assistance identified. Residents interviewed gave conflicting statements to their care plans. Staff interviewed were consistent in explaining the process of communication within the team through the phone system when assistance is needed to provide 2 person transfers for residents.

Interviews of Administrator (AD) and Director of Nursing (DON) were conducted and reveal the facility procedure for meeting reporting requirements. This Department interviewed a witness who confirmed communication from the facility related to an identified incident in the past. This was a requirement of the facility. Interviews with care staff reveal conflicting information regarding which department reports to whom when an incident occurs. A staff member reported that concerning matters can be reported to a Med Tech rather than to a Manager. The facility was unable to locate or provide a report of an incident regarding R6 which was said to have been submitted by previous Management.

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.

SUPERVISORS NAME: Shawna Doucette
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

LIC9099 (FAS) - (06/04)

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