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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216801868
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:39:59 PM

Document Has Been Signed on 01/29/2025 03:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ALMAVIA OF SAN RAFAELFACILITY NUMBER:
216801868
ADMINISTRATOR/
DIRECTOR:
ANGELA BOUCHER-TURINFACILITY TYPE:
740
ADDRESS:515 NORTHGATE DRIVETELEPHONE:
(415) 491-1900
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 160CENSUS: 116DATE:
01/29/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Executive Director, Angie Boucher-TurinTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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At approximately 1:40PM, Licensing Program Analysts (LPAs) Felias and Deniz arrived unannounced to conduct a Case Management - Incident Visit and met with Executive Director/Administrator, Angie Boucher-Turin. The purpose of the visit was to follow up on documentation for a case management visit that was conducted on 11/22/2024.

On 11/22/2024, LPA conducted a case management visit regarding self-submitted incident reports. During visit, LPA followed up on a report regarding missing medications. It was identified that the missing medications were narcotics and the facility was in the process of conducting an internal investigation and working alongside San Rafael Police.

Per discussion with Executive Director the facility conducted the following: an internal investigation, a medication audit and a narcotic count which was conducted alongside a Nurse Consultant. San Rafael Police were also contacted to conduct their own investigation.

LPAs obtained additional documentation related to the incident.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Executive Director. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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