<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600964
Report Date: 07/28/2022
Date Signed: 07/28/2022 02:33:29 PM


Document Has Been Signed on 07/28/2022 02:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KENSINGTON PLACE REDWOOD CITYFACILITY NUMBER:
415600964
ADMINISTRATOR:GREIG O'CONNORFACILITY TYPE:
740
ADDRESS:2800 EL CAMINO REALTELEPHONE:
(650) 363-9200
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:67CENSUS: 52DATE:
07/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Joan NewmanTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management inspection visit in response to a notification made to the Department regarding concerns of facility funds. LPA met with administrator Joan Newman and explained the purpose of today's visit.

LPA toured the facility inside and out with Joan. Facility is two floors. LPA observed activities taking place on both floors. Staff are observed in place supervising residents through out. Utilities are on and functioning. Residents observed are having their needs being met during today's inspection. Ambient temperature is comfortable for residents and staff. Sufficient lighting is present in all areas observed. According to Joan there is no direct impact made to residents or their funds or facility operations.

Kitchen is observed as well for food supplies. LPA observed main refrigerator and freezer is fully stocked. Perishable and nonperishable food supplies are observed as in place. According to the director of dining services, Tony Ng, confirms food deliveries have been made on time with no issues. Sysco delivery is made weekly, produce is delivered daily except on Sundays, and bakery deliveries are made weekly. No issues ordering food supplies are reported. Kitchen appliances are functioning.

LPA received a staff roster of who is working during the time of this visit as well as a resident roster.

No deficiencies cited. Report reviewed with Joan.
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1