198601953-9-30-2025-28-AS-DSIS-DMEUPF-20251013154529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601953
Report Date: 09/30/2025
Date Signed: 09/30/2025 02:47:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250924154207

FACILITY NAME:	KENSINGTON SIERRA MADRE, THE		FACILITY NUMBER:	198601953
ADMINISTRATOR:	CECILIA DEGRAFF		FACILITY TYPE:	740
ADDRESS:	245 W. SIERRA MADRE BLVD.		TELEPHONE:	(626) 355-5700
CITY:	SIERRA MADRE	STATE: CA	ZIP CODE:	91024
CAPACITY:	106	CENSUS: 88	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Daniel Orozco, Executive Director		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff do not safeguard the residents confidential information

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Initial 10-Day complaint investigation visit regarding the above allegation. LPA discussed the purpose of the visit with the Executive Director, Daniel Orozco.

The investigation consisted of the following: LPA requested a copy of staff and resident rosters. LPA interviewed the Executive Director, Staff #1 (S1) - Staff #6 (S6), Resident #1 (R1) - Resident #9 (R9), and Witness #1 (W1) - Witness #2 (W2). LPA also obtained documents from R1’s file such as the face sheet, Physician’s Report, Admission Agreement. LPA also obtained staff in-service training, and documents from S1’s file such as Staff Training such as Resident Rights and HIPAA (Health Insurance Portability and Accountability Act).

[Continue in LIC9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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 28-AS-20250924154207

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KENSINGTON SIERRA MADRE, THE	FACILITY NUMBER: 198601953
	VISIT DATE: 09/30/2025

NARRATIVE

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The investigation revealed the following in regards to the allegation: “Staff do not safeguard the resident’s confidential information,” it is alleged that staff did not safeguard the resident’s personal information by allowing a to third party business access to a resident’s personal information which resulted in the sale of resident’s personal property. LPA interviewed Executive Director and six (6) out of six (6) staff denied the allegation staff stated that residents' personal and confidential information is never provided to anyone that is not staff or personnel who work at the facility. Executive Director and six (6) out of six (6) staff stated that the facility policy of providing the resident’s confidential information to third parties is not allowed. LPA interviewed nine (9) out of nine (9) residents, the residents denied knowledge of the allegation and stated that the facility staff safeguard the residents’ confidential information. Eight (8) out of nine (9) residents stated that the facility staff are not involved in selling residents personal property. One (1) out of nine (9) residents stated staff do not coerce or pressure the residents to sell the residents personal property. Nine (9) out of nine (9) residents stated feeling safe at the facility. LPA interviewed R1’s Power of Attorney (W1) and W2, and both W1 and W2 denied the allegation and reported that R1’s family is involved in the sale of the R1’s personal property and W1 states R1 is in agreement of the sale of R1s personal property. Two (2) out of two (2) witnesses also stated that the facility staff are not involved in the sale of R1’s personal property. W1 reported that staff did not allow access of R1’s confidential and personal information to a third party. LPA reviewed staff #1 (S1) in-service training and training records regarding Resident’s Personal Rights and HIPAA Laws. Per Executive Director, there are no staff that have been provided with verbal or written warnings regarding not safeguarding residents’ confidential and personal information. Therefore, the investigation did not reveal a preponderance of evidence to support the allegation.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was held and a copy of this report was provided to the Executive Director, Daniel Orozco.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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