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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011404238
Report Date: 12/29/2022
Date Signed: 12/29/2022 12:23:18 PM

Document Has Been Signed on 12/29/2022 12:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:David De Almeida, Co- AdministratorTIME COMPLETED:
12:30 PM
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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. This Case Management is the result of complaint #15-AS-20221206135534. LPAs met with David De Almeida, Co-Administrator (S2) and explained the purpose for the visit..

On 12/08/22, W1 stated that the facility had an infestation of bed bugs. When interviewed by LPA L. Holmes W1 stated that lice and bed bugs were the same. W1 stated that the facility illegally evicted C4 and C4 had no where to go. According to CCIB, C4 was also present with W1. C4 reported that the facility had weapons on the premises and on an unknown date someone pulled out a gun. No further details provided by W1 at that time.

On 12/22/22, LPA interviewed W1. W1 questioned who made the statement about guns and said, "Scratch that!" 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 the above complaint 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.

Interviews with S2 revealed that the facility did not have any knowledge of a gun or weapons on the premises, and that C4 never reported having a gun, seeing a gun, and/or having lice. Several Clients go into the community and have brought bags back to the home. A local church offers free food, but often times there may be fruit flies present. S2 and the staff makes every attempt to inspect the items brought in for bugs. A inspection of the facility will be completed by S2 for guns, weapons and other harmful objects. C4 was issued a 30 Day notice on 11/09/2022 due to physical and verbal behavior. The notice was never enforced. S2, W1, and W2 stated that C4 did not want to return to that facility and has had a change in his/her behaviors.

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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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