216800331-5-27-2020-21-AS-CMAZ-BQ6TVX-20200601150440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216800331
Report Date: 05/22/2020
Date Signed: 05/27/2020 11:29:27 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
04/27/2020 and conducted by Evaluator Carla Fernandes-Goes

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200427163630

FACILITY NAME:	ATRIA TAMALPAIS CREEK		FACILITY NUMBER:	216800331
ADMINISTRATOR:	TANCHOCO, CORRINE		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:	02:15 PM
MET WITH:	Jocelyn Vahle - Resident Care Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff does not treat resident with dignity.

Staff are serving cold food.

INVESTIGATION FINDINGS:

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

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 Corrine Tanchoco – Executive Director.

On 4/29/2020 at 10:15 AM, LPA Fernandes-Goes open the complaint investigation. During interviews and documentation acquired review for resident R1, LPA learned that facility has residents’ meals being delivered to their rooms due to COVID-19 instead using the dining room. At this time meals are delivered on a cart no more than five meals at a time. Meals are covered with aluminum foil and/or plastic wrap. LPA also learned, some residents are still in bed and not ready to eat when meals are served.

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)

Page: 1 of 2

Control Number 21-AS-20200427163630

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In regard to resident treatment, staff have been going in pairs when attending to resident R1. Staff interviewed stated that when attending resident, they have not observed any staff not being cordial and/or not treating resident with dignity. In addition, staff interview stated that resident R1 didn’t like all the staff that might be on schedule for their care. Based on interviews and documentation review LPA wasn’t able to prove or disprove that staff doesn’t treat resident with dignity and/or that food is being served cold.

According to complaint allegations of “Staff does not treat resident with dignity.” and “Staff are serving cold food.” 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)

Page: 2 of 2