385600270-9-20-2024-14-AS-AMEN-D9U9S8-20241007233703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600270
Report Date: 09/20/2024
Date Signed: 09/20/2024 03:59:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
08/23/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20240823163924

FACILITY NAME:	ALMA VIA OF SAN FRANCISCO		FACILITY NUMBER:	385600270
ADMINISTRATOR:	CLEITUS JONES		FACILITY TYPE:	740
ADDRESS:	ONE THOMAS MORE WAY		TELEPHONE:	(415) 337-1339
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY:	175	CENSUS: 134	DATE:	09/20/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Cleitus Jones, Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident sustained injuries due to staff neglect
Staff did not ensure facility transport vehicle was not in disrepair

INVESTIGATION FINDINGS:

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On 9/20/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Cleitus Jones. LPA toured the facility, interviewed staff, gathered facility documents and made observations during the course of the investigation.

Complaint alleges resident sustained injuries due to staff neglect. Based upon interviews with Executive Director and staff (S1) it was found that S1 had provided assistance to resident (R1) during transportation to an appointment on 8/22/2024. The facility van wheelchair lift was not in proper electronic functioning order but is also equipped with a manual hand crank lever located inside the vehicle. S1 stated that they assist residents into the wheelchair lift based on transportation practices for wheelchair assistance by placing residents facing forwards and outside the vehicle. During the event, S1 had properly loaded R1, facing forwards towards the outside of the vehicle while S1 had operated the manual lift from the inside of the vehicle. It was found that R1 had sustained minor injury from falling forward from the wheelchair. However, there is a lack of corroborating evidence to prove that the incident was due to intent or neglect as staff were following proper manual device transportation protocols, therefore the allegation is unsubstantiated.
Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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-20240823163924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ALMA VIA OF SAN FRANCISCO	FACILITY NUMBER: 385600270
	VISIT DATE: 09/20/2024

NARRATIVE

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Complaint alleges staff did not ensure facility transport vehicle was not in disrepair. Based upon interviews with Executive Director, staff (S1) and LPA observations, it was found that the facility vehicle wheelchair lift had not been in electronic operating condition for a period of time. The facility was aware of the device needing repair and had documentation of cost quotes for repairs. LPA observed lift with staff (S1) showing that the lift does not electronically retract back into the vehicle. However, the lift is equipped with a manual hand crank to operate in case of electronic failure. Although the van lift electronic system is not in repair, the van lift is still equipped to properly execute its function. Due to contradicting information gathered and a lack of corroborating evidence, the allegation is found to be unsubstantiated.

A finding that the complaint allegations, resident sustained injuries due to staff neglect
and staff did not ensure facility transport vehicle was not in disrepair are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC9099 (FAS) - (06/04)

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