216800331-7-21-2021-21-AS-KMOA-C5CMDU-20210728093143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216800331
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:42:22 PM

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
04/06/2021 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20210406145601

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:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Corrine Tanchoco		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
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5
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7
8
9

Resident was unlawfully evicted

Personal Rights

INVESTIGATION FINDINGS:

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

At approximately 1:45PM, Licenseing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to complete an investigation into the above allegations. LPA met with Executive Director Corrine Tanchoco and Resident Service Director Jocelyn Vahle. Based on interviews conducted and a review of records, R1 was not evicted. Facility conducted discussions with one of the responsible parties regarding increasing care needs but the information did not result in an eviction. R1 moved from the facility on 8/30/2020. LPA reviewed documents and did not find any special food orders or precautions. There were no incidents or accusations in the record that were violations of any personal right.

This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No citations issued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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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