198601953-5-15-2025-28-AS-WSHO-DGY89Q-20250523221931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601953
Report Date: 05/15/2025
Date Signed: 05/15/2025 04:23:28 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, 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
05/09/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250509100758

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: 90	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Daniel Orozco, Associate Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is in disrepair.
Staff did not provide adequate supervision to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced 10 day complaint visit to investigate the allegations listed above. LPA met with Daniel Orozco, Associate Executive Director who assisted with the visit. The reason for the visit was explained.

The investigation consisted of the following: Interview(s) with Staff 1 - Staff 5 (S1 - S5), Resident 1- Resident 8 ( R1 - R8), obtained copies of staff and residents roster, Staff structure, Staff schedule for April and May 2025, invoice from Vortex Industries, LLC, Police report number, tour of facility, including common areas, front area and patio area.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

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-20250509100758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: KENSINGTON SIERRA MADRE, THE	FACILITY NUMBER: 198601953
	VISIT DATE: 05/15/2025

NARRATIVE

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Regarding allegation: Facility is in disrepair. It was alleged that the front entrance of the facility remained broken for weeks, leaving residents exposed to unnecessary security risks. At the time of visit LPA observed that front entrance of the facility not broken and functional. Interviewed staff mentioned that last week the front entrance door automatic mechanism wasn't working properly, had a mechanical malfunction, requiring manual opening and closing. The repair was completed less than 24-hour hours and SIR dated 05/08/25 about entrance door malfunction was sent to the Department (SIR was provided to LPA). Interviewed staff stated even though the entrance door had mechanical issue, the door still did lock and perform its function. and in addition facility has a 24-hour concierge who diligently monitors the entrance and exit ensuring the safety of building and residents. All interviewed residents stated that everything works at the facility and not aware of facility being in disrepair.

Regarding allegation: Staff did not provide adequate supervision to residents in care. It was alleged that there have been repeated incidents of injuries involving residents, and the police have been called to the facility. At the time of visit LPA observed that facility have enough staff who provide adequate supervision to residents. Interviewed staff denied the allegation. They stated that there are always enough staff to assist the residents and always adequate supervision and do not recall that there were repeated incident of injuries involving residents. Interviewed S1 and S2 stated that they have 45-50 employees per shift including caregivers, housekeepers, medical staff, dining servers and activity coordinators. Also, in the event of urgent staffing need, facility closely work with three staffing agencies to help cover it. Interviewed staff stated that they have had several visits the past few weeks from Law enforcement due to complaint that reported to them ( Copies of SIR, SOC 341 were provided to LPA) Police department came to the facility to conduct the interviews with various staff members as part of their standard procedures, but these visits did not disrupt the daily operations of the community and no further investigation was reported. (Copies of Police Officer business card with the case number was provided to LPA).

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250509100758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: KENSINGTON SIERRA MADRE, THE	FACILITY NUMBER: 198601953
	VISIT DATE: 05/15/2025

NARRATIVE

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Interviewed residents stated that there is always enough staff at the facility, and they provided adequate supervision. They stated that they don't have any concerns about the staff and not aware of any incidents of injuries involving residents. LPA reviewed the staff roster / schedule which indicated adequate staff coverage at all times.

Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegations. Although the allegations may have happened or is valid, there are not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and the copy of this report was provided to Daniel Orozco, Associate Executive Director

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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