107206939-4-14-2026-24-AS-SDOE-DU2U66-20260513151750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206939
Report Date: 04/14/2026
Date Signed: 04/14/2026 10:06:04 PM

Substantiated

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
09/18/2025 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250918130833

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: 95	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Administrator, Alexis Alvarez		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not provide adequate transportation services

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint investigation. LPA met with and explained the reason for the visit with Administrator (AD) Alexis Alvarez and Jami Young (DON). During this visit, LPA obtained documents for review and conducted interviews.

Interviews reveal that on 6/27/25, a resident suffered a heat-related incident in the facility van. While the facility rescheduled some afternoon activities due to summer heat, afternoon medical transportation continued. On 3/12/26, an inspection by the LPA, AD, and DON confirmed the van’s air conditioning was not operating at full capacity. Maintenance records for the van were provided and reviewed, but there is no documentation of air conditioning service. The preponderance of evidence standard has been met, therefore the above allegation found to be SUBSTANTIATED.

A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D.
An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were provided via email.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

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 5

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
09/18/2025 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250918130833

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:	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Alexis Alvarez		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not provide a comfortable temperature for residents
Staff are not meeting the residents bathing needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint investigation. LPA met with and explained the reason for the visit with Administrator (AD) Alexis Alvarez and Jami Young (DON). During this visit, LPA obtained documents for review and conducted interviews.

Record review was conducted of Patton Air invoices dated June-October 2025. Invoices document multiple visits and ongoing repairs to areas of the facility such as kitchen, hallway ceilings on first and second floors and specific resident air conditioning units. The Reporting Party does not provide a specific incident or resident to investigate.

Interviews reveal that the facility water was shut off due to necessary plumbing repairs on 9/11/25 and 9/12/25. The shut off was communicated to residents. Per interview shower schedules were adjusted in Memory Care (MC). Selected Assisted Living (AL) residents shower logs were reviewed and show that shower assistance was provided on both of these days.
See LIC9099-C for continuation

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 24-AS-20250918130833

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: 04/14/2026

NARRATIVE

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The Reporting Party did not identify a specific resident, date or incident to be investigated.

Based on interview and record review 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: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
09/18/2025 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250918130833

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: 95	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Adminidtrator, Alexis Alvarez		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
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5
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8
9

Staff did not provide adequate food service

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 24-AS-20250918130833

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/30/2026 Section Cited CCR 87312	1 2 3 4 5 6 7	87312 Motor Vehicles Used in Transporting Residents Only drivers licensed... Any vehicle used by the facility to transport residents shall be maintained in a safe operating condition. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	AD has agreed to submit a written statement to CCL which contains a plan to meet the requirements of the regulation as well as meets facility activities and appointment commitments. The plan will be submitted to CCL by poc date.
	8 9 10 11 12 13 14	Licensee did not ensure the facility van used to transport residents on outings and to appointments is maintained in a safe operating condition.The van air conditioning has not been maintained. 6/27/25 R1 became ill related to heat on a facility outong on the van. This is a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

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