385600270-4-17-2025-14-AS-ACON-DHGP8F-20250609110524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600270
Report Date: 04/02/2025
Date Signed: 04/17/2025 03:15:47 PM

Substantiated

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
04/26/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20240426082005

FACILITY NAME:	ALMA VIA OF SAN FRANCISCO		FACILITY NUMBER:	385600270
ADMINISTRATOR:	R		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:	09:35 AM
MET WITH:	Cleitus Jones, Executive Director		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff did not provide proper notice of rate increase

INVESTIGATION FINDINGS:

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**This report is an amended version of original LIC9099 dated 4/2/2025**
On 4/17/2025, 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 facility staff did not provide proper notice of rate increase for resident (R1). Reporting party indicated the following dates: 7/31/2020, 4/30/2021, 4/30/2022, 1/27/2023, 1/30/2024, with an additional noted increase on 8/1/2020. Upon a review of resident (R1) records, LPA gathered all dated notifications of rate increases on file.

Continued onto LIC9099-C

Substantiated

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: 04/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025

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-20240426082005

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

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**This report is an amended version of original LIC9099-C dated 4/2/2025**
Upon further review of the alleged rate increase on 8/1/2020, LPA found that upon R1’s admission, a move-in confirmation record was completed and indicated R1’s move-in level of care rate. The document was signed by R1’s financial responsible party (I1) agreeing to the rate. Based on a review of R1’s payment ledger and invoice, LPA found that the facility provided an adjusted rate for R1 upon admission. The facility began charging R1 the original agreed upon move-in level of care rate as of 8/1/2020. Based on LPA findings, this alleged date of 8/1/2020 is not determined as a rate increase.

Upon further review of R1's payment ledger corresponding invoices and rate of increase notice dated 7/31/2020; effective 10/1/2020 LPA identified inconsistencies of fee amounts charged that do not match the addendum rate. The facility also failed to include modified conditions and rate structure in the notice when in comparison to the ledger and invoice. It was found that effective 10/1/2020, the monthly rate increased to $4885. However, ledger indicates a monthly rate of $5595 with a $710 market adjustment applied. This information of modification and rate structure was not clearly indicated on the notice dated 7/31/2020 or corresponding invoice which is determined an improper notice.

Upon further review of R1’s payment ledger corresponding invoices and rate of increase notice dated 4/30/2021; effective 7/1/2021, LPA identified inconsistencies of fee amounts charged that do not follow the addendum rate modified conditions and rate structure stated in the notice when in comparison to the ledger. It was found that effective 7/1/2021, the monthly rate increased to $5700 with an approved monthly fee discount of $710. However, ledger and invoice does not have any indication of the discount applied based on the notice dated 4/30/2021 which is determined an improper notice.

Allegation, facility staff did not provide proper notice of rate increase is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on separate 809-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.

Citation issued on corresponding Facility Evaluation Report LIC809.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025

LIC9099 (FAS) - (06/04)

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