385600270-4-10-2023-14-AS-CSMH-CQVTRR-20230414145759

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600270
Report Date: 04/10/2023
Date Signed: 04/10/2023 11:55:05 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 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
04/05/2023 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230405130326

FACILITY NAME:	ALMA VIA OF SAN FRANCISCO		FACILITY NUMBER:	385600270
ADMINISTRATOR:	ALAN FOX		FACILITY TYPE:	740
ADDRESS:	ONE THOMAS MORE WAY		TELEPHONE:	(415) 337-1339
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY:	175	CENSUS: 120	DATE:	04/10/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Memory Care Director, Adriana Garcia		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Refusing to take resident back

INVESTIGATION FINDINGS:

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On 4/10/2023, Licensing Program Analyst (LPA), Murial Han conducted an unannounce on-site complaint inspection for complaint number 14-AS-20230405130326. LPA met memory care director and explained the purpose of the visit.

Regarding to allegation of- facility refusing to take resident back, the reporting party stated that resident #1 (R1) was transferred to the hospital for a skin condition and when R1 was ready to go back to the facility, the facility refused to take R1 back.

As part of the investigation, LPA spoke memory care director who denied the allegation and stated that R1 was transferred to the hospital on 3/31/2023 due to a change of skin condition.

After a few days of hospital stay, on 4/3/2023, the hospital Case Manager (CM) called the facility and spoke to staff #1 (S1) that R1 was ready to be discharged back to the facility and no other details were provided regarding to R1's wound and/or wound care.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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 14-AS-20230405130326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALMA VIA OF SAN FRANCISCO	FACILITY NUMBER: 385600270
	VISIT DATE: 04/10/2023

NARRATIVE

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After the phone call, S1 contacted the memory care director informing him/her that the hospital was ready to transfer R1 back to the facility. Subsequently, the memory care director also got a call from the hospital CM informing that R1 was ready to be discharged. The memory care director state that the facility needed to conduct an on-site assessment on the following day to assess R1's health condition and to develop a treatment plan upon R1's return,

On the next day (4/4/2023), the administrator went to assess R1 at the hospital and R1 returned on 4/5/2023 with hospital discharge instructions. Currently, R1 is under the care of home health for wound care/treatment.

Based on the facility's documentation, the administrator assessed R1 on 4/4/2023 and hospital instruction indicated R1 was discharged back to the facility on 4/5/2023.

After the investigation, this allegation is deemed to be unfounded as R1 returned to the facility.

After the investigation, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

This report is reviewed and discussed memory care director.

A copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Murial Han	TELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC9099 (FAS) - (06/04)

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