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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011404238
Report Date: 12/29/2022
Date Signed: 12/29/2022 12:28:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/06/2022 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20221206135534
FACILITY NAME:TIA MARIA FAMILY HOMEFACILITY NUMBER:
011404238
ADMINISTRATOR:MARIA A. DE ALMEIDAFACILITY TYPE:
735
ADDRESS:28175 RUUS ROADTELEPHONE:
(510) 887-6221
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:28CENSUS: 25DATE:
12/29/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:David De Almeida, Co-Administrator TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Facility has bedbugs
client is missing clothing, shoes, towels and cell phone
INVESTIGATION FINDINGS:
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On 12/29/2022 at 11:00 AM, Licensing Program Analysts (LPAs) L. Holmes and K. Nguyen arrived unannounced to deliver complaint findings for the above allegations. LPAs met with David De Almeida, Co-Administrator (S2) and explained the purpose of the visit.

During the course of the investigation, LPAs S1, S2, W1, and 3 Clients. LPAs obtained C4’s Preplacement Appraisal, Identification and Emergency Information, Admission Agreement, Physician’s Report, Functional Capability Assessment, 30 Day Eviction Notice, Client Roster, Pest Control Report, Hayward Police Department Report receipt, toured the facility, and inspected C4’s bedroom.

...continued on LIC9099C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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 2
Control Number 15-AS-20221206135534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TIA MARIA FAMILY HOME
FACILITY NUMBER: 011404238
VISIT DATE: 12/29/2022
NARRATIVE
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...continued from LIC9099

Allegation: Facility has bedbugs.
Based on documents received and interviews, the facility had a proactive treatment plan for pest control in place before and after the allegation. S1 and the Pest Control Company inspected on 11/14/22 and 12/15/22 without any record of bedbugs.

Allegation: client is missing clothing, shoes, towels, and cell phone refers to C4. C4’s Client/Resident Personal Property and Valuables does not indicate any property; however, W1 picked up C4’s personal items the week of 12/04/22. When S1 was interviewed, there weren’t any reports of missing articles, including a cellular phone. S1 was not aware of C4 ever owning a cellular phone and would contact C4 via the facility’s house phone. W1 stated that C4 had a cellular phone for close to three years no know one knew. W1 stated that C4 was not available for reach and the cellular number was disconnected. LPA attempted to reach C4 by phone, but the number rang to an unidentified voicemail. On 12/22/22, LPA spoke with W1 and W2 regarding photos for he above allegations. Photos were to be sent by W1 to CCLD on 12/22/22 and was never received. LPA attempted to contact W1 on 12/28/22 and left a voicemail; no reply.

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

Exit interview conducted and a copy of this report provided to Co-Administrator, David De Almeida.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2