210102761-3-30-2023-21-AS-HDBI-CTG72N-20230705211658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 210102761
Report Date: 03/30/2023
Date Signed: 03/30/2023 09:24:39 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2023 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20230126093548

FACILITY NAME:	TAMALPAIS		FACILITY NUMBER:	210102761
ADMINISTRATOR:	TUMBALE, TERENCE		FACILITY TYPE:	741
ADDRESS:	501 VIA CASITAS		TELEPHONE:	(415) 461-2300
CITY:	GREENBRAE	STATE: CA	ZIP CODE:	94904
CAPACITY:	341	CENSUS: 257	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Terence Tumbale, Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Food Services
Personal Rights (Staffing)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hansen conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced on this day for the purpose of delivering findings of the above allegations. LPA met with Administrator, Terence Tumbale.

Food Services – Per Reporting party, there has been a sharp decline in food services and food choices. This Department conducted unannounced site visits on 2/2/2023, 2/16/2023, and 3/7/2023, during these visits, toured the buildings and grounds, interviewed (2) two staff and (7) seven residents, reviewed and obtained records. The food supply and facility menus were observed by LPA at each unannounced site visit - the facility had adequate perishable and non-perishable food and menus were consistent with the requirements of Title 22 regulations. Based on interviews conducted by LPA, contradictory information was received related to food service and choices, although there is a consensus that there is plenty of fresh food options. Although the allegations may be true or valid, there is not a preponderance of evidence to prove that the allegation are, or are not, true. Therefore, the allegation is found to be UNSUBSTANTIATED.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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 21-AS-20230126093548

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: TAMALPAIS	FACILITY NUMBER: 210102761
	VISIT DATE: 03/30/2023

NARRATIVE

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Personal Rights (Staffing) – Complaint alleges facility has a reduction dinning staff, Health Center staff, and Clinic staff resulting in severely restricted services. LPA conducted unannounced site visits on 2/2/23, 2/16/23, and on 3/7/2023 where LPA toured the buildings and grounds, conducted interviews with (7) seven residents who reside in both the Assisted and Independent Living floors of the facility. LPA obtained documentation related to staffing and during each visit, LPA observed staff in the dining room, Health Center, and Clinic. Interviews concluded that although there may have been more staffing previously, the lack of staffing has not restricted services to residents. Although the allegations may be true or valid, there is not a preponderance of evidence to prove that the allegations are, or are not, true. Therefore, the allegations are found to be UNSUBSTANTIATED.

Exit interview conducted with Administrator Terence Tumbale and a copy of this report was given.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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