216803029-2-17-2022-21-AS-BMOS-CCZLRA-20220330085849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803029
Report Date: 02/17/2022
Date Signed: 02/17/2022 11:22:22 AM

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
10/04/2021 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20211004104313

FACILITY NAME:	AEGIS ASSISTED LIVING OF CORTE MADERA		FACILITY NUMBER:	216803029
ADMINISTRATOR:	KAUFMANN, LEE E.		FACILITY TYPE:	740
ADDRESS:	5555 PARADISE DRIVE		TELEPHONE:	(415) 927-4200
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY:	150	CENSUS: 112	DATE:	02/17/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Bill Phelps, GM & Vice President of Operations Development		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Facility is impeding the removal of the resident’s personal property by their Resident Representative
Facility did not make resident’s records available to the responsible party
Facility did not safeguard resident's personal property.
Facility not adhering to Admissions Agreement.
Facility is not answering communications from Resident's Representative promptly and appropriately.

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 Bill Phelps, GM & Vice President of Operations Development.

Facility is impeding the removal of the resident’s personal property by their resident representative. – LPA’s conducted interviews, reviewed records and made observations during investigation. Based on LPAs interviews with interim administrator, responsible party (RP) and multiple staff it was revealed responsible party was present at the facility on a few occasions to go through and pack R1s personal belongings. LPA obtained an email dated 10/1/2021 of interim Administrator and responsible party communication indicating the efforts to coordinate the removal of R1s personal belongings by hired moving company. Although complainant alleges facility was impeding the removal of R1s belongings LPAs were unable to obtain information to support this allegation. Therefore, this allegation is unsubstantiated.
Continue on 9099-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: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

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 5

Control Number 21-AS-20211004104313

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: AEGIS ASSISTED LIVING OF CORTE MADERA	FACILITY NUMBER: 216803029
	VISIT DATE: 02/17/2022

NARRATIVE

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Facility did not make residents records available to the responsible party- Complainant alleges resident records requested from the facility, not limited to financial records were not provided upon request. Based on LPAs interviews, record review, and emails obtained during the investigation, the facility appears to have provided records for R1 to responsible party via email and in person. Although responsible party alleges not receiving these records the investigation revealed conflicting information and LPA was unable to obtain information to support facility did not provide R1s records to responsible party. Therefore, this allegation is unsubstantiated.

Facility did not safeguard resident’s personal property - Complainant alleges R1s belongings had been rifled through and left in a disorganized manor. Complainant also alleges that R1s purse was missing. LPA conducted interviews with interim administrator and obtained emails of correspondence between previous administrator and complainant in regard to concerns of R1s personal property. LPA was unable to obtain information to support R1s personal belongings were not safeguarded prior to R1s responsible party moving belongings out of facility. Therefore, this allegation is unsubstantiated.

Facility not adhering to Admissions agreement – Complainant alleges that facility is not following the admission agreement based on the removal of R1s personal belongings after R1s passing. Complainant alleges that facility is not providing refund of the community fee and did not provide a copy of the admission agreement. R1 signed the admission agreement in 2010 and RP confirmed obtaining a copy, but it was located in storage. Based on emails obtained R1s RP did not meet the agreement to be refunded to community fee. LPA was unable to obtain information to support facility is not adhering to admission agreement signed by R1 in 2010. Therefore, the allegation is unsubstantiated.

Continue on 9099-C2

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 21-AS-20211004104313

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: AEGIS ASSISTED LIVING OF CORTE MADERA	FACILITY NUMBER: 216803029
	VISIT DATE: 02/17/2022

NARRATIVE

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Facility is not answering communications from Resident’s Representative promptly and appropriately. LPA conducted interviews and reviewed records. LPA obtained email correspondence between R1s responsible party and previous Administrator, current General Manager and different departments in the facility. Email dates of correspondence obtained are 09/20/2021, 09/28/2021, 09/29/2021, 09/30/2021, 10/1/2021, 10/3/2021, 10/15/2021. Although the complainant alleges facility is not responding to RPs communication LPA was unable to obtain information to support this allegation. Therefore, this allegation is unsubstantiated.

Although the allegations above 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 allegations are unsubstantiated.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
10/04/2021 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20211004104313

FACILITY NAME:	AEGIS ASSISTED LIVING OF CORTE MADERA		FACILITY NUMBER:	216803029
ADMINISTRATOR:	KAUFMANN, LEE E.		FACILITY TYPE:	740
ADDRESS:	5555 PARADISE DRIVE		TELEPHONE:	(415) 927-4200
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY:	150	CENSUS:	DATE:	02/17/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Bill Phelps, GM & Vice President of Operations Development		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Resident’s representative did not receive copies of Admissions Agreement

Facility did not provide written notice to Resident’s Representative of the policies regarding contract termination upon death and refunds

INVESTIGATION FINDINGS:

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Unfounded

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: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 21-AS-20211004104313

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: AEGIS ASSISTED LIVING OF CORTE MADERA	FACILITY NUMBER: 216803029
	VISIT DATE: 02/17/2022

NARRATIVE

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Facility did not provide written notice to Resident’s Representative of the policies regarding contract termination upon death and refunds- LPA’s initial interview with complainant confirmed RP has possession of admissions agreement which address policies regarding contract termination upon death and refunds. The investigation revealed RP has been provided the policies regarding termination upon death and refunds, Therefore the allegation is unfounded.

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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5