216803891-6-1-2023-21-AS-HDBI-CT38XY-20230622225504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803891
Report Date: 06/01/2023
Date Signed: 06/01/2023 01:39:24 PM

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
04/04/2023 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230404091216

FACILITY NAME:	MARIN TERRACE		FACILITY NUMBER:	216803891
ADMINISTRATOR:	THOMAS EISEMAN		FACILITY TYPE:	740
ADDRESS:	297 MILLER AVE		TELEPHONE:	(415) 388-9526
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY:	49	CENSUS: 18	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Erlinda Ferris (Executive Director)		TIME COMPLETED:	01:54 PM

ALLEGATION(S):

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-Staff refused to seek medical attention for resident
-Staff made inappropriate comments towards resident
-Staff confine residents to their rooms

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Executive Director Erlinda Ferris.

There is an allegation that staff refused to seek medical attention for resident. It was alleged that resident R1 called reporting party around 6 am on 4/3/2023 said that they have been complaining to the staff about not feeling well, but staff came in their room and told them to be quite because R1 is crazy, so reporting party ended up having to call 911. LPA attempted to contact reporting party to gather additional information using phone number provided, but call was unable to be completed as dialed. LPA conducted confidential interviews with staff and residents in care. Staff (S1) provided LPA with a copy of R1’s daily progress notes, it was described that on 4/2/23 at approximate 10am, 911 was contacted then the police contacted the facility to ensure that R1 was fine. Although, on 4/24/23 LPA have followed up submitting a request to Southern Marin Fire Department, the call was not found on their records.
Continue on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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-20230404091216

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: MARIN TERRACE	FACILITY NUMBER: 216803891
	VISIT DATE: 06/01/2023

NARRATIVE

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Continues from LIC9099...

Based on records review provided by the facility revealed that R1 have been seen in a regular basis by their Physician including hospitalization. However, LPA reviewed incident report logs for this facility, and it was determined that incident reports regarding R1’s hospitalization were not submitted to CCL per regulation. Administrator could not provide proof that incidents were reported to CCL within seven days after occurrence. LPA will address reporting requirements on a case management inspection. Although, incidents including hospitalizations were not submitted to CCL facility provided proof that they had been seeking medical attention for R1 when needed. A finding that the complaint allegation staff refused to seek medical attention for resident is 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.

Regarding the allegation of staff made inappropriate comments towards resident. Per online complaint received, it was alleged that staff (no name was provided) has come to R1’s room and told R1 “to be quite because R1 was crazy”. On 4/4/23 and 4/21/23 LPA performed facility visits and conducted confidential interviews with staff and residents in care. Based on interviews conducted with staff and residents in care, statements made to LPA do not corroborate or concerns were raised regarding any staff making inappropriate comments towards any resident. Also, there is no name provided by neither party to support the above allegation. A finding that the complaint allegation staff made inappropriate comments towards resident is 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.

The last allegation is about staff confine residents to their rooms. Per online anonymous complaint received, the reporting party alleges that they had been told that some residents (no names provided) with dementia are being confined to rooms. On 4/4/23 and 4/21/23 LPA have conducted unannounced visits to the facility, made observations and conducted confidential interviews with five residents and four staff. LPA was unable to find any evidence or indication that this allegation could be supported. A finding that the complaint staff confine residents to their rooms is 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.

Exit Interview conducted with Executive Director Erlinda Ferris and a copy of this report was given.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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