385600270-8-7-2020-14-AS-JMOS-BSAV5C-20200808160741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600270
Report Date: 08/07/2020
Date Signed: 08/07/2020 02:55:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2020 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20200519144325

FACILITY NAME:	ALMA VIA OF SAN FRANCISCO		FACILITY NUMBER:	385600270
ADMINISTRATOR:	BENITO DEL TORO		FACILITY TYPE:	740
ADDRESS:	ONE THOMAS MORE WAY		TELEPHONE:	(415) 337-1339
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY:	175	CENSUS: 114	DATE:	08/07/2020
		UNANNOUNCED	TIME BEGAN:	10:43 AM
MET WITH:	Benito Del Toro		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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-Facility staff did not notice a change in resident's condition
-Facility staff did not update the resident's needs and services plan after a change in the resident's condition
-Facility staff did not provide a written notice of rate increase to resident's authorized representative
-Facility illegally evicted resident
-Facility staff did not provide a copy of the resident's records to the resident's authorized representative in a timely manner
-Facility staff did not report incidents to licensing

INVESTIGATION FINDINGS:

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Today 8/7/20 Licensing Program Analyst (LPA) Chris Hopkins delivered an amended report that was originally created on 7/24/20. During the investigation of the allegations above LPA received copies of admission agreement, incident reports, needs and services plan, rate increase letters, eviction notice, and copy of resident representative email along with facility response email.

Regarding allegations that facility staff did not notice a change in resident's condition; facility staff did not report incidents to licensing; and facility staff did not update the resident's needs and services plan after a change in the resident's condition, the Department investigation found the following: The resident was admitted to the facility in September 2017. During the resident's stay at the facility, periodic assessments were made, and the resident experienced minimal change in behavior, requiring no additional care and supervision beyond that offered at intake. The resident then experienced a sudden behavioral change on April 7, 2020.

Report continued on LIC9099c...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

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 14-AS-20200519144325

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALMA VIA OF SAN FRANCISCO	FACILITY NUMBER: 385600270
	VISIT DATE: 08/07/2020

NARRATIVE

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On April 7, 2020 the resident walked up to a female resident in the garden common area, striking the female resident in the face without reason. On May 6, 2020 the resident again showed a violent outburst and became aggressive towards staff. The resident yelled for help and two staff came to see what was happening, he then struck those two staff in various parts of their bodies without reason. The documentation collected shows that the facility reported the incident as required, made the necessary documentation about the incident, sent incident reports to CCLD, and contacted primary physician for a change of medication.

Regarding the allegation that the facility staff did not provide a written notice of rate increase to resident's authorized representative. The department found the following: the facility provided annual notices on April 30, 2018 and April 30, 2019 to the resident's representatives indicating the rate increase.

Regarding the allegation that the facility illegally evicted resident. The department found the following: A 30-day eviction notice was issued on May 12, 2020; the notice indicated the reasons for eviction; the notice noted that the resident’s condition changed, and he hit a resident along with two staff (as indicated above). The notice met all the requirements established under Section 87224 of Title 22 of the California Code of Regulations.

Regarding the allegation that facility staff failed to provide a copy of the resident's records to the resident's authorized representative in a timely manner, the licensee provided a copy of an email from resident representative requesting copies of several documents; the licensee also provided a copy of the response email that was sent to the family within 5 hours, with the requested documents sent as attachments.

The department has investigated these allegations and based on the documentation we have found that the complaint was UNFOUNDED, meaning that these allegations were false, could not have happened and/or is without a reasonable basis.

Report reviewed with Executive Director, Benito Del Toro. An electronic copy of the report was emailed to Benito Del Toro for signature.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

LIC9099 (FAS) - (06/04)

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