385600270-4-2-2025-14-AS-KHOS-DFYHC5-20250422060408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600270
Report Date: 04/02/2025
Date Signed: 04/02/2025 11:55:47 AM

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
02/03/2025 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20250203162006

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:	DATE:	04/02/2025
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Cleitus Jones, Executive Director		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Prior to admission staff did not provide resident or resident's authorized person with an appraisal of the resident's individual service needs
Staff did not provide records to resident or resident's authorized person upon request

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 4/2/2025, LPA Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Cleitus Jones. LPA interviewed staff, resident and outside parties and reviewed resident records during the course of the investigation.

Complaint alleges prior to admission staff did not provide resident or resident's authorized person with an appraisal of the resident's individual service needs. Upon review of resident records, LPA determined that prior to resident (R1’s) admission, the facility had completed an appraisal for R1. LPA interviewed R1 who stated that they did not have concerns of the facility not completing or providing their care plan. R1 indicated that the facility is meeting their needs and is very satisfied with the care provided. In addition, R1 can determine their own health needs and does not have or require a responsible party for health needs and decisions.

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: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 14-AS-20250203162006

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: 04/02/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R1 indicated to speak with their responsible party (I1). Upon interview with I1 LPA received contradicting information towards the allegation. Due inconsistent information gathered and to a lack of corroborating evidence, the allegation is found to be unsubstantiated.

Complaint alleges staff did not provide records to resident or resident's authorized person upon request. LPA interviewed resident (R1) who stated that they did not have any concerns or report that the facility was not providing records. R1 can determine their own health needs, request their own medical and care records and stated that they have not requested any documents from the facility. R1 indicated to speak with their responsible party (I1). Upon interview with I1 LPA received contradicting information towards the allegation. Due inconsistent information gathered and to a lack of corroborating evidence, the allegation is found to be unsubstantiated.

A finding that the complaint allegation alleges facility staff did not provide proper notice of rate increase is 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. No deficiency cited.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2