216801868-7-24-2023-21-AS-KMOA-CU6NK2-20230728103112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216801868
Report Date: 07/24/2023
Date Signed: 07/24/2023 04:00:06 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
07/21/2023 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20230721160514

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: 130	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Executive Director/Administrator, Angle Boucher-Turin		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility is not maintained at a comfortable temperature for residents in care
Resident's Air Conditioning unit is in disrepair

INVESTIGATION FINDINGS:

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At approximately 2:25PM, Licensing Program Analyst (LPA) Felias arrived unannounced to initiate a Complaint Investigation regarding the above allegations and met with Executive Director/Administrator, Angie Boucher-Turin.

During the Investigation, LPA conducted interviews and made observations. There are allegations that Facility is not maintaining a comfortable temperature for residents in care, and Resident's Air Conditioning unit is in disrepair. The report received on 07/21/2023 states that Resident 1's (R1's) air conditioning unit is not functioning and the work request that was submitted has not been completed. The report also states that the third floor of the facility is uncomfortably hot. On 07/24/2023, LPA was informed by the Reporting Party that R1's air conditioning unit was replaced and is functional. LPA was also informed that the air conditioning for the facility was observed to be operable and working.

Continued on LIC9099C

Unsubstantiated

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: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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-20230721160514

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: 07/24/2023

NARRATIVE

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Continued from LIC9099

LPA conducted a walk through of the facility and observed that the air conditioning unit in R1's room was functioning appropriately. LPA also observed that the thermostat temperature for the common space in Memory Care was 75 degrees Fahrenheit, while the thermostat temperatures on the first and third floors of Assisted Living were 73 degrees and 69 degrees Fahrenheit. Per Title 22 Regulations - 87303 Maintenance and Operation, facilities must maintain a comfortable temperature between 68 degrees and 85 degrees Fahrenheit, therefore the facility is within regulation.

The allegations of Facility is not maintaining a comfortable temperature for residents in care, and Resident's Air Conditioning unit is in disrepair is Unsubstantiated.

A finding that a complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted. Copy of report discussed and LIC811 (Confidential Names) 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: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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