216801868-5-4-2023-21-AS-CMAZ-CRMLC2-20230508083737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216801868
Report Date: 05/04/2023
Date Signed: 05/04/2023 01:51:30 PM

Unfounded

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
05/02/2023 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20230502124601

FACILITY NAME:	ALMAVIA OF SAN RAFAEL		FACILITY NUMBER:	216801868
ADMINISTRATOR:	ANGELA BOUCHER-TURIN		FACILITY TYPE:	740
ADDRESS:	515 NORTHGATE DRIVE		TELEPHONE:	(415) 491-1900
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	160	CENSUS: 132	DATE:	05/04/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director/Administrator, Angie Boucher-Turin		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to initiate a Complaint Investigation regarding the above allegation and met with Executive Director/Administrator, Angie Boucher-Turin.
During the course of the investigation, LPA requested and reviewed documents, conducted interviews and made observations. There is an allegation of an Unlawful Eviction. Record Review showed that an Eviction Letter was provided to Resident 1 (R1) and their Responsible Party on 4/26/2023 with all of the required elements and wording per Title 22 regulations. Per Title 22 regulations, Division 6, Chapter 8, Article 04 - Operating Requirements, Number 87224, entitled “Eviction Procedures,” the facility provided R1 and their Responsible Party an Eviction Letter that included the following: the full name of the resident, the address of the facility resident was being evicted from, the licensee’s signature and date, the reasons for the eviction, the effective date of the eviction, resources available to assist the resident in finding alternative housing, information about the resident’s right to file a complaint with Community Care Licensing (CCL) and included phone numbers for CCL and the State Ombudsman.
Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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-20230502124601

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: ALMAVIA OF SAN RAFAEL	FACILITY NUMBER: 216801868
	VISIT DATE: 05/04/2023

NARRATIVE

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Continued from LIC9099

The Eviction also included appropriate wording regarding “unlawful detainer” if the resident were to stay beyond the eviction date. The reason for the Eviction was a legitimate reason under regulation 87224(a)(3), entitled “Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement.”

Review of R1’s Residency and Service Agreement, dated 03/30/2016, showed that R1 and their Responsible Party were made aware of the Facility’s General Policies, and Resident Handbook Policies upon move in. The facility also conducted care conferences with R1 and their Responsible Party to address R1’s behaviors and incidents on 02/16/2021 and 09/09/2021, where the Facility’s General Policies and Resident Handbook Policies were re-reviewed. Incident Reports dated 03/20/2023, 04/03/2023, and 04/20/2023 showed that the Facility informed R1’s Responsible Party of the incidents. Reports showed that Facility made attempts to schedule another care conference with the Responsible Party but were denied. Facility documentation also revealed that R1’s incidents involved both facility staff and residents. R1’s incidents showed that their behaviors infringed on the Personal Rights of other residents residing at the facility.

Based on documents reviewed, interviews conducted, and observations made, this Agency has investigated the above allegation. We have found that the complaint of Unlawful Eviction is UNFOUNDED. A finding that the complaint is UNFOUNDED meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

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