216803891-9-30-2022-21-AS-BMOS-CK4MPD-20221011094657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803891
Report Date: 09/29/2022
Date Signed: 09/30/2022 10:30:08 AM

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
08/04/2022 and conducted by Evaluator Carla Fernandes-Goes

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220804125304

FACILITY NAME:	MARIN TERRACE		FACILITY NUMBER:	216803891
ADMINISTRATOR:	WILLIAMS, DARNELL		FACILITY TYPE:	740
ADDRESS:	297 MILLER AVE		TELEPHONE:	(415) 388-9526
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY:	49	CENSUS: 23	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Darnell Williams - Executive Director		TIME COMPLETED:	12:18 PM

ALLEGATION(S):

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Staff handles residents in a rough manner

INVESTIGATION FINDINGS:

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The Department conducted a complaint investigation regarding the allegation listed above. Licensing Program Analyst Fernandes-Goes arrived unannounced for the purpose of closing the investigation and met with Darnell Williams - Executive Director.

On August 8th 2022, LPA Fernandes-Goes conducted an unannounced visit to facility; conducted interviews and requested documentation. During investigation of allegation above, Department conducted interviews with complainant, residents, responsible parties (POAs) and staff on 8/8/22, 9/7/22, 9/23/22, and 9/26/22; and reviewed documentation provided by facility. Department learned that even though complainant has concerns regarding handling of residents by caregiving staff, interviewed individuals stated that they have no concerns regarding this matter.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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-20220804125304

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: 09/29/2022

NARRATIVE

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POA RP1A stated “’we’ are there often if not daily and we have no problems with that…very actively involved and we have never had a concern or my family members otherwise we would have taken ‘resident’ out of the facility.” In addition, POA RP4 stated “I have never seen anything like that.” Staff interviewed share the same statement as POAs regarding residents being handled roughly. Based on interviews, Department wasn’t able to prove or disprove that residents' are being handled in a rough manner by staff.

A finding that the complaint allegations of "Staff handles residents in a rough manner.” 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.

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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