216803994-4-11-2023-21-AS-CMAZ-CR7PJ7-20230424112104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803994
Report Date: 04/11/2023
Date Signed: 04/11/2023 02:16:09 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
03/01/2023 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20230301161214

FACILITY NAME:	AEGIS LIVING CORTE MADERA		FACILITY NUMBER:	216803994
ADMINISTRATOR:	STAMETS, DONALD		FACILITY TYPE:	740
ADDRESS:	5555 PARADISE DRIVE		TELEPHONE:	(415) 483-1399
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY:	150	CENSUS: 116	DATE:	04/11/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Donald Stamets, Administrator		TIME COMPLETED:	02:08 PM

ALLEGATION(S):

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Staff inappropriately touched a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hansen arrived unannounced on 04/11/2023 to deliver findings regarding the above allegation. LPA met with Executive Director, Donald Stamets.
During the investigation, the Department conducted interviews, reviewed documents, and made observations.
There was an allegation that Facility staff inappropriately touched a resident while in care.
Reporting Party (RP) reported to the Department on 3/1/2023 that Resident (R1) had been inappropriately touched by Staff (S1) resulting in a bruise on left breast and R1 express they feel unsafe around S1.
During the investigation, R1 gave inconsistent statements to the investigator and other parties when questioned about the alleged abuse. Inconsistent information involving the time, location and details of the alleged abuse and abuser. The department conducted subsequent interviews with Residents, Staff, Police Department and Outside Parties which concluded that there wasn’t enough corroborating evidence to support the allegation. S1 suffers from dementia and memory loss.

Continue on LIC9099-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: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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-20230301161214

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 LIVING CORTE MADERA	FACILITY NUMBER: 216803994
	VISIT DATE: 04/11/2023

NARRATIVE

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S1 denied inappropriately touching R1.
Investigation with the Central Marin Police Department (PD) concluded due to lack of evidence they closed the case.
A finding that the complaint allegation of “Staff inappropriately touched a resident while in care” is unsubstantiated. 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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

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