011404238-11-8-2023-15-AS-YFLS-D6CNVH-20240618104755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011404238
Report Date: 11/08/2023
Date Signed: 11/08/2023 02:12:56 PM

Substantiated

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
03/16/2023 and conducted by Evaluator Luisa Fontanilla

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230316100902

FACILITY NAME:	TIA MARIA FAMILY HOME		FACILITY NUMBER:	011404238
ADMINISTRATOR:	MARIA A. DE ALMEIDA		FACILITY TYPE:	735
ADDRESS:	28175 RUUS ROAD		TELEPHONE:	(510) 887-6221
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	28	CENSUS: 28	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	David De Almeida		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Residents have access to illegal drugs

INVESTIGATION FINDINGS:

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On this day at around 1 PM, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to deliver finding on the above allegation and met with Donny Brown. LPA explained to staff the purpose of the visit. LPA spoke with Administrator on the phone and informed him about LPA presence at the facility. Administrator arrived at the facility at around 1:56pm. .

On 3/20/2023, Licensing Program Analyst (LPA) Daisy Panlilio initiated 10-day investigation and obtained records. On 3/16/2023, the above complaint was referred to Investigations Branch (IB) and was accepted as an assignment. On 4/13/2023, IB upgraded the complaint to a full investigation.

Residents have access to illegal drugs
During the course of investigation, the Department conducted interviews and reviewed records including but not limited to coroner’s report, police report, incident reports, medical records, medical assessments, etc.
continuation on Lic 9099C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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-20230316100902

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: 11/08/2023

NARRATIVE

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Staff reported Client 2 (C2) had a known drug history and history of bringing drugs into the facility. However, staff failed to implement proper search procedures or other safety measures to ensure the safety of C2 and other clients in care. Administrator David de Almeida confirmed there were no written procedures regarding searches. He instructed staff to keep their eyes open and confiscate contraband if it was in plain sight. No other measures were implemented to prevent drugs from entering the facility.

David stated multiple times C2 used drugs “like they were cigarettes.” Multiple staff reported witnessing C2 using drugs “20 to 30 times.” Staff 1 (S1) and Staff 2 (S2) denied searching C2 after returning to the facility despite knowing C2 used drugs on a regular basis. Video recordings showed C2 overdosing on drugs inside his bedroom.

On 3/30/2023 client 6 (C6) was found unresponsive in C2’s room next to a small bag of crystalline substance. Alameda County Coroner’s Bureau determined C6’s cause of death as acute fentanyl intoxication. Hayward Police Department collected and booked into evidence a white substance in a plastic bag, plastic straw, 34.7 grams of suspected fentanyl, and a pipe. Staff denied conducting a search of C2 the day prior to C6’s death. Individuals reported to Hayward Police Department officers that C2 made a comment that he should not have given C6 such a “large dose.”

Based on interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099D.

Exit interview was conducted with Administrator and Appeal Rights was provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230316100902

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/10/2023 Section Cited CCR 85075.4(b)	1 2 3 4 5 6 7	85075.4 (b) Observation of the Client (b) The licensee shall provide assistance when observation reveals needs which might require a change in the existing level of service, or possible discharge or transfer to another type of facility. This requirement is not met as evidenced by: Based on interviews and record reviews conducted by the Department, facility was aware that C1 has a known drug history and history of bringing drugs into the facility. However, staff failed to implement proper search procedures or other safety measures to ensure the safety of C2 and other clients in care.	1 2 3 4 5 6 7	Plans of Corrections (POCs) will be addressed in a NonCompliance Conference.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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