198601953-1-27-2025-28-AS-RORN-DE8PRT-20250225103316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601953
Report Date: 01/27/2025
Date Signed: 01/27/2025 05:18:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/22/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250122115205

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: 89	DATE:	01/27/2025
		UNANNOUNCED	TIME BEGAN:	02:48 PM
MET WITH:	Cecilia 'CC' DeGraff - Senior Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff are not providing adequate transportation services to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Cecilia DeGraff, Senior Executive Director and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters, a copy of resident's Admission Agreement containing basic and optional transportation services, Medical and non medical Tansportation Logs/schedule (Jan. 2025), owner's email permission to use company vehicle, Resident council meeting minutes (12/17/2024) and 2025 transportation memo to residents/family members. LPA interviewed Staff #1 (S1) - Staff #5 (S5) and Resident #1 (R1) - Resident #9 (R9).

The investigation revealed the following: in regards to the allegation " Facility staff are not providing adequate transportation services to residents". It is alleged that between 01/13/2025 - 01/22/2025, multiple medical appointments for residents have been turned down and rescheduled due to a staff member using the medical transportation company vehicle for personal purposes. ***CONTINUED ON 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

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-20250122115205

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KENSINGTON SIERRA MADRE, THE	FACILITY NUMBER: 198601953
	VISIT DATE: 01/27/2025

NARRATIVE

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(5) out of (5) staff interviewed denied the allegation. Interviewed staff indicated that nurses are in charge of scheduling transportation for residents' medical appointments. All staff members interviewed indicated that they have not canceled transportation or re-scheduled appointments for residents from Jan. 13 to Jan. 22, 2025, due to the company vehicle being unavailable. Staff interviewed stated that if a resident's appointment is cancelled, it is because the doctor is unavailable or because a resident's family member has canceled it. Staff also indicated that although it seldom happens, staff arrange other services like Uber/Lyft, or dial-a-ride or insurance transportation for last-minute appointments. S1 stated that she used the company vehicle a few times during the fire evacuation and between Jan. 17-26, 2025, but there were no disruptions to residents' appointments. (9) out of (9) residents interviewed could not corroborate the allegation. All interviewed residents indicated that staff always provided transportation to their medical appointments without issues. Interviewed residents indicated that transportation to their medical appointments has not been canceled due to the facility's vehicle being unavailable. LPA reviewed a transportation log/schedule for the month of January 2025 and showed no cancellations or re-scheduling due to vehicle unavailability. Therefore, there was insufficient evidence to corroborate with the allegation.

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

Exit interview held, and a copy of this report was provided to Cecilia DeGraff, Senior Executive Director.

SUPERVISOR'S NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

LIC9099 (FAS) - (06/04)

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