Inspection visit

complaintSeptember 29, 2021

Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

LPA observed that the level of care was lower during the initial admission and that the Admission Agreement was followed. This was confirmed during a review of resident records and the Admission Agreement. Complaint alleges that facility is short staffed. Based on record review, LPA learned that the staff Roster appeared to be appropriate at the time of the review. In addition, two subsequent complaint inspection investigations were conducted unannounced on June 16, 2021 and July 16, 2021. LPA observed sufficient amount of staff members present at the facility. Complaint alleges that staff failed to execute Emergency Disaster Plan. Based on record review, LPA learned throughout the investigation that the last Emergency Disaster drill was conducted on March 16, 2021 along with the Life Safety System Inspection. Complaint alleges that staff are mismanaging residents’ medication. Based on interviews, LPA learned through a follow-up interview that the Doctor changed the medication which does not have anything to do with the facility mismanaging the residents’ medication. Complaint alleges that Facility is not allowing resident to have visitations. Based on record review, LPA reviewed the visitation records for the time frame of May to July 2021 and learned that the Responsible Party along with another individual was visiting the resident from late May to Late June 2021. The visitation log was appropriately filled out and signed by individuals entering and departing the facility. Based on the interviews that were conducted, the observation of the facility and the documents/evidence reviewed, the allegations of, Staff does not communicate with resident representative regarding resident's care needs, facility is short staffed, facility staff did not have resident re-appraised, facility does not adhere to Admissions Agreement, staff failed to execute emergency disaster plan, staff are mismanaging resident's medications, facility is not allowing resident to have visitations will be Unsubstantiated. A finding that the complaint allegations are unsubstantiated, meaning that although the allegations 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. Exit interview was conducted and a copy of this report was signed and given to the Administrator.

Citations

2 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

87211Type B
87211 Reporting Requirements:(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.(A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.(C) The use of an Automated External Defibrillator.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met evidenced by:Based on interviews with facility staff, and research of incident reports submitted for Almavia of San Rafael to CCL, did not properly report an incident to the CCL as required by Title 22 regulation. This poses a potential health, safety or personal rights risk to persons in care.
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87465Type A
87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement was not met as evidenced by:Based on an email conversation dated for July 23, 2021, it was disclosed that facility missed a Urinalysis order for R1 in May 2021. This poses an immediate health, safety or personal rights risk to persons in care.
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FAQ · About this visit

Common questions about this visit

What happened during the September 29, 2021 inspection of ALMAVIA OF SAN RAFAEL?

This was a complaint inspection of ALMAVIA OF SAN RAFAEL on September 29, 2021. The inspection found no deficiencies and no citations were issued.

Were any citations issued to ALMAVIA OF SAN RAFAEL on September 29, 2021?

No citations were issued during this inspection. The facility was found to be in compliance with all applicable regulations.

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

complaint·September 29, 2021