019201182-4-24-2026-15-AS-BFOG-DTNQW2-20260501123114

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201182
Report Date: 04/24/2026
Date Signed: 04/24/2026 03:50:34 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
04/16/2026 and conducted by Evaluator David Doidge

COMPLAINT CONTROL NUMBER: 15-AS-20260416105136

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: 135	DATE:	04/24/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Directo Kirsten Korfhage		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff did not ensure residents apartment was fixed timely

Staff did not assist resident with moving apartments due to water damage

Staff didn't ensure leak was fixed properly

INVESTIGATION FINDINGS:

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On 04/24/2026 at 09:45 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation in regards to the allegations above. LPA met with Executive Directo Kirsten Korfhage and explained the purpose of the visit.

During the course of the investigation, LPA interviewed S1, S2, R1 and attempted to speak with R2. LPA obtained copies of correspondence between R1’s Responsible Party (RP) and the facility, and an established timeline for the event that occurred.

Allegation: Staff did not ensure residents apartment was fixed timely

Investigation Findings: It was reported to the department that a cleaning woman reported to the victim that she had been in the unit after the flooding prior to April 8 and saw the water damage, but did not report it. LPA interviewed S4. S4 cleans R1’s room weekly on Wednesdays.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026

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-20260416105136

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: 04/24/2026

NARRATIVE

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Continued from lIC9099

S4 entered R1’s room to find the floors buckled but dry. S4 informed LPA S4 did not say anything to staff as S4 did not know whether or not the floor issue had already been reported. S4 said the floor was dry and S4 did a light vacuuming and left the room. S4 informed LPA that R1 questioned S4 about the water damage, but did not know when it occurred and conveyed that to R1. R1 informed LPA that on April eighth R1 arrived home and saw the laminate floor was buckled and the front door was hard to open. R1 stated R1 waited until the next day, April 9th, to inform the facility staff of the damage. S1 informed LPA that that same day, April 9th, S3 went to R1’s room, saw the damage, and told R1 that the head of maintenance, S3, would be out to inspect and assess the damage on Monday the 13th. R1 confirmed that S3 came out on Monday the 13th to inspect and assess where the leak came from. S1 informed LPA that management determined the floor needed to be replaced and found R1 a temporary apartment to stay in that same day. S1 informed LPA that the facility has offered R1 a choice of eight apartments to move into, and R1 has selected a new apartment to move in to, with a move in day set for April 24th. LPA confirm with R1 that R1 has held off moving R1’s belongings into the new room until R1 feels ready to move in. LPA confirmed that R1 is staying in a temporary room as R1 is not ready to move into the new apartment. Based on interviews this allegation is UNSUBSTANTIATED.

Allegation: Staff did not assist resident with moving apartments due to water damage

Investigation Findings: It was reported to the department that the victim should move out and that the victim would need to personally pay for all of the moving expenses with no assistance being offered by the facility. W1 informed LPA that W1 had only heard initial remarks from R1 about R1 needing to move. W1 did not confirm that R1 said R1 would be expected to pay and was speculating based on how upset R1 was during their initial conversation. W1 did not have firsthand interactions with staff\ and informed LPA that those remarks were based on W1’s impression of W1 and R1's conversation. S1 informed LPA that staff have moved R1’s bed and a few furniture items to both the temporary apartment and later to R1’s new apartment. R1 confirmed that the facility did move R1’s bed and a few furniture pieces to both rooms. LPA inspected all three rooms to confirm items had been moved. R1 informed LPA that staff have spoken to RP and R1 about the move, and RP and S1 have sorted out the details. S1 stated RP will hire a moving company to move R1’s remaining items and will reimburse RP. R1 is currently waiting to have R1’s belongings moved until R1 is ready to move. Based on interviews and documented conversations, this allegation is UNSUBSTANTIATED.

Continued on LIC9099-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260416105136

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: 04/24/2026

NARRATIVE

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Continued from LIC9099-C

Allegation: Staff didn't ensure leak was fixed properly

Investigation Findings: It was reported to the department that R1’s unit had flooded due to the negligence of the upstairs neighbor. W1 informed LPA that W1 thought R1’s apartment was flooded due to an upstairs neighbor flooding his/her’s room. S1 informed LPA that S3 had inspected both rooms and reported that the water damage was due to a faucet being left on in R2’s room. not due to a broken water pipe. LPA inspected both rooms and saw that there is water damage to both rooms, but no water flowing. LPA could not see an ongoing leak. R2 would not speak to LPA to confirm where or not R2 left a faucet on. S1 informed LPA that S3 determined the water damage in R1’s room came from a faucet in R2’’s room. Based on interviews and inspection, this allegation is UNSUBSTANTIATED.

Based on interviews, inspection and record reviews conducted, the above allegations are unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies observed or cited during this visit.

Exit interview conducted and a copy this report was provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026

LIC9099 (FAS) - (06/04)

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