210102761-3-30-2023-21-AS-BMOS-CQLNPV-20230405103854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 210102761
Report Date: 03/30/2023
Date Signed: 03/30/2023 09:47:04 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
02/08/2023 and conducted by Evaluator Shannan Hansen

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230208103553

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: 222	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Terence Tumbale, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights-staff spoke inappropriately to residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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.
Personal Rights-staff spoke inappropriately to residents in care – Reporting Party alleges resident’s personal rights were violated. On 1/26/2023 Community Care Licensing (CCL) received 3 self-reported SOC 341’s of alleged verbal aggression by staff to residents in care. Upon learning of this the facility Administrator immediately suspended staff pending an internal investigation. On 2/16/2023 LPA arrived at facility to open a complaint investigation. LPA obtained facility documents and conducted interviews with the following; three (3) resident, three (3) staff, a private care giver, and the Administrator. LPA reviewed documentation of Suspected Abuse Report (SOC341), and emails regarding the facility’s internal investigation. Based on interviews, record reviews and observations made, there is not enough information to prove or disprove the personal rights of residents were violated by facility staff speaking inappropriately to residents in care.
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.

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)

Page: 1 of 1