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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600964
Report Date: 10/09/2024
Date Signed: 10/09/2024 04:52:13 PM


Document Has Been Signed on 10/09/2024 04:52 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KENSINGTON PLACE REDWOOD CITYFACILITY NUMBER:
415600964
ADMINISTRATOR:JOAN NEWMANFACILITY TYPE:
740
ADDRESS:2800 EL CAMINO REALTELEPHONE:
(650) 363-9200
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:67CENSUS: 53DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Rita Malhotra, Clinical Support Specialist, Jassi Kaur, Director of Memory Care, and Alberto Golia, Executive Director TIME COMPLETED:
05:00 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 October 9, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:01 AM to conduct the unannounced 1-year Annual Inspection. LPA Calandra was greeted by Jassi Kaur, Director of Memory Care, and Rita Malhotra, Clinical Support Specialist and explained the purpose of the visit. Alberto Golia, Executive Director arrived later during the visit.

LPA toured the physical plant, This is a 2-story building with 39 bedrooms and bathrooms, a parlor, cafe, kitchen, activity room, staff lounge, lobby, laundry. All bedrooms had the required furniture and sufficient lighting. All bathrooms had the required grab bars and anti-skid floor mats. All smoke alarms and carbon monoxide detectors were observed to be in working order. Per interview with Danilo Barbieri, Director of Environmental Services the facility's fire alarms and Carbon Monoxide detectors are connected directly to the Redwood City Fire Department. No accessible bodies of water or hazards were observed in the outdoor area.

All sharp objects, poisons, detergents, and soap were locked and in-accessible to persons in care.

LPA Calandra reviewed 5 staff files and 10 resident files. All were observed to be complete.

LPA reviewed resident medications which matched the Centrally Stored Medication Records(CSMR) kept at the facility

LPA received a copy of the facility's current Liability Insurance during the visit.

No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Alberto Golia, Executive Director, Rita Malhotra, Clinical Support Specialist and Carol Blackwell, RN/Director of Nursing.
SUPERVISOR'S NAME: Andrea MedlinTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John CalandraTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024
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