216800331-5-27-2020-21-AS-CMAZ-BQ6TRF-20200601145725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216800331
Report Date: 05/22/2020
Date Signed: 05/27/2020 11:49:01 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2020 and conducted by Evaluator Carla Fernandes-Goes

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200214140703

FACILITY NAME:	ATRIA TAMALPAIS CREEK		FACILITY NUMBER:	216800331
ADMINISTRATOR:	RIVERA, MELON		FACILITY TYPE:	740
ADDRESS:	853 TAMALPAIS AVE		TELEPHONE:	(415) 892-0944
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	180	CENSUS: 78	DATE:	05/22/2020
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Jocelyn Vahle - Resident Care Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff failed to treat resident with dignity and respect.

Facility staff used inappropriate language towards the resident.

Staff yells at resident.

Staff forces resident to take showers at unreasonable time.

INVESTIGATION FINDINGS:

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The Department conducted a complaint investigation regarding the allegations listed above. Licensing Program Analyst Fernandes-Goes conducted a telephone visit due to COVID-19 unannounced for the purpose of closing the investigation and met with Jocelyn Vahle – Resident Care Director.

On 3/10/2020 at 1:45 PM, LPA Fernandes-Goes open the complaint investigation, toured the facility, made observations, and conducted interviews. LPA learned that resident R1 is scheduled to take showers Mondays & Thursdays at 1:30/2:00 PM. According to documentation requested and interviews facility has a designated caregiver that gives resident a shower twice a week. Caregiver schedule at the facility is always in the afternoon. Schedule for showers must always be in the afternoon. (see copies)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2020

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-20200214140703

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: ATRIA TAMALPAIS CREEK	FACILITY NUMBER: 216800331
	VISIT DATE: 05/22/2020

NARRATIVE

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In regard to resident not being treated with dignity, inappropriate language towards the resident, and that staff yells at resident, during interviews and documentation review for resident R1, LPA learned that staff provides care for resident always in twos and staff have not observed any other staff not being cordial, not treating resident with dignity, using inappropriate language, and/or yelling at resident. In addition, staff interview stated that resident R1 didn’t like all the staff that might be on schedule for their care and a maintenance staff has observed resident yelling at staff. Based on interviews and documentation review LPA wasn’t able to prove or disprove that staff is mistreating resident, using inappropriate language, yelling and/or that showers are at an unreasonable time.

According to complaint allegations of “Facility staff failed to treat resident with dignity and respect.”; “Facility staff used inappropriate language towards the resident.”; “Staff yells at resident.”; and “Staff forces resident to take showers at unreasonable time.” are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2020

LIC9099 (FAS) - (06/04)

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