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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201241
Report Date: 08/27/2025
Date Signed: 08/27/2025 06:02:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
08/22/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250822142027
FACILITY NAME:KENSINGTON AT WALNUT CREEK, THEFACILITY NUMBER:
079201241
ADMINISTRATOR:VILLANUEVA, JOSEPHFACILITY TYPE:
740
ADDRESS:1580 GEARY ROADTELEPHONE:
(925) 973-1121
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:200CENSUS: 156DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Deborah Bradley, Assistant Executive DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Unlawful eviction
INVESTIGATION FINDINGS:
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On 08/27/2025 at 12:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct an initial 10-day complaint investigation in regard to the allegation above. LPA met with Assistant Executive Director, Deborah Bradley and Interim Executive Director, Ricardo Romero and informed the reason for visit.

During the course of investigation, LPA L. Alexander interviewed witnesses (W), staff (S) and obtained copies of documented letters dated 11/22/24, 06/12/25, Kensington statements dated 06/01/25, 07/01/25, 08/01/25, payment ledger for R1's account, Contra Costa County Notice of Action letter dated 03/01/25, 30-Day Notice to Pay or Quit dated 07/21/25 and 07/24/25.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 15-AS-20250822142027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: KENSINGTON AT WALNUT CREEK, THE
FACILITY NUMBER: 079201241
VISIT DATE: 08/27/2025
NARRATIVE
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LIC9099-C (Page 2)

Allegation: Unlawful eviction
Substantiated.

On 08/27/2025 LPA L. Alexander interviewed with W1, W2 and W3 that all stated that the eviction notice that was given to R1 on 07/24/2025 did not have the appropriate contact information for the local ombudsman. W1 and W2 stated that they never received notice that the eviction was rescinded. W1 and W2 stated that they understand that the eviction date would be 08/24/25 which would be 30 days.

LPA reviewed the 30-Day Eviction Notice back on 08/15/25 and advised S1 that the contact information for the ombudsman was incorrect and to rescind the notice.

S1 and S2 both stated that they did not rescind the notice but are working on a revision. S2 stated that as of 08/27/25 the statement of rescinding the 30-Day eviction notice was sent to R1's responsible party.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. Appeal rights and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250822142027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: KENSINGTON AT WALNUT CREEK, THE
FACILITY NUMBER: 079201241
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2025
Section Cited
HSC
1569.683(a)(3)
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§1569.683 Eviction notices (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident...with specific facts to permit the notice to quit shall include all of the following: (3) Information about the resident's right to file a complaint...with the name, address, and telephone number of the nearest office of.. the State Ombudsman.

This requirement is not met as evidenced by:
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The Administrator will read the regulation and submit self-certification that it has been read, understood and they will comply going forward to CCLD by POC due date. In addition, the licensee shall rescind the eviction, notify resident's responsible party, and issue legal notice if that is still licensee’s plan.
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Based on record review and interview, the licensee did not comply with the section cited above in by not sending the notice to evict with the correct contact information for the local Ombudsman to R1's responsible party which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3