216801868-1-23-2026-21-AS-KMOA-DR8MCY-20260212083017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216801868
Report Date: 01/23/2026
Date Signed: 01/23/2026 03:38:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2025 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20251104150332

FACILITY NAME:	ALMAVIA OF SAN RAFAEL		FACILITY NUMBER:	216801868
ADMINISTRATOR:	CARLA SANCHEZ		FACILITY TYPE:	740
ADDRESS:	515 NORTHGATE DRIVE		TELEPHONE:	(415) 491-1900
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	160	CENSUS: 103	DATE:	01/23/2026
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Executive Director, Tracy Freudendahl		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not follow reporting requirements

INVESTIGATION FINDINGS:

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At approximately 8:25AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with Executive Director, Tracy Freudendahl.

During the course of the investigation, the Department requested and reviewed documents and made observations. The following allegation was investigated, "Staff did not follow reporting requirements." Complaint alleged that Resident 1's (R1's) responsible party was not notified of a fall that resulted in R1 going to the hospital. Report stated that R1 had a fall on 10/31/2025 and that the responsible party was not notified until 11/03/2025 when they visited the facility and was handed a written report by facility staff. Report further states that the responsible party's phone number was called but a voicemail was not left and therefore does not consitute as a notification.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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 21-AS-20251104150332

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 RAFAEL	FACILITY NUMBER: 216801868
	VISIT DATE: 01/23/2026

NARRATIVE

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Continued from LIC9099

Per Title 22 Regulations, Reporting Requirements, 87211(a)(1), "(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..."

Review of R1's facility documents showed that an incident report submitted to the Santa Rosa Regional Office (SRRO) on 11/05/2025 which stated that on 10/31/2025, R1 was found on the floor with a cut on their cheek. Emergency personnel was contacted and R1 was transported to the hospital for further evaluation. Report also states that R1's emergency contact was notified. Facility documentation also showed that R1's responsible party was contacted on 10/31/2025 at 5:44AM via telephone. Text message correspondence provided to the Department also showed that on 11/03/2025, R1's responsible party was informed that R1 did have a fall and that facility staff called.

Review showed that facility notified R1's responsible party within the regulation's time frame of seven days, as a written report was also provided on 11/03/2025 which was three days after the incident occurred.

Based on record review and observations made, this allegation is Unsubstantiated. A finding that a complaint allegation is Unsubstantiated means 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.

Exit interview conducted. Copy of report discussed and provided to Executive Director/Administrator. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

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