019201182-2-21-2025-15-AS-BFOG-DE93NC-20250225172343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201182
Report Date: 02/21/2025
Date Signed: 02/21/2025 05:08:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/19/2025 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20250219150136

FACILITY NAME:	LAKE PARK SENIOR LIVING		FACILITY NUMBER:	019201182
ADMINISTRATOR:	KORFHAGE, KIRSTEN		FACILITY TYPE:	741
ADDRESS:	1850 ALICE STREET		TELEPHONE:	(510) 835-5511
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94612
CAPACITY:	275	CENSUS: 100	DATE:	02/21/2025
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Executive Director, Kirsten Korfhage		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Facility elevator is in disrepair.

INVESTIGATION FINDINGS:

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On 02/21/2025 at 1:20 PM, Licensing Program Analyst (LPA) D. Doidge unannounced to conduct a 10 day initial complaint investigation for the allegation above. Upon arrival, LPA met with Executive Director (ED), Kirsten Korfhage, and explained the reason for the visit.

During the course of the investigation, LPA conducted an interview with ED, reviewed and received copies of email coorrespondence with the elevator manufacturer for the elevator. LPA also interviewed residents.

Allegation: Facility elevator is in disrepair.
Investigation Finding: Un-Substantiated

It was reported to the Department that the facility's elevator is in disrepair. Upon observeation of rhe elevator, interviews and review of service/maitance logs, LPA determined elevator is in process of being repaired.

Continued on LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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 15-AS-20250219150136

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: LAKE PARK SENIOR LIVING	FACILITY NUMBER: 019201182
	VISIT DATE: 02/21/2025

NARRATIVE

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Continued from LIC9099

Elevator 2 stopped working early January. ED informed Otis, the elevator manufacture, and put in a service request. On February 3rd, Otis technicians repaired by installing the part and informed ED they would need to come back to put the elevator back in operation. The facility is waiting for Otis to come back out and finish the job. In the meantime, ED has been in contact with three (3) other repair companies to either repair or replace the current elevators. ED has documentation showing there is a not only a plan to repair the elevators, but a reasonable timeline for the repair has been established.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation the facility’s elevator is in disrepair does not meet Regulation Requirements is un-substantiated.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC9099 (FAS) - (06/04)

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