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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430700017
Report Date: 08/24/2023
Date Signed: 08/24/2023 04:27:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/30/2022 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20220830145656
FACILITY NAME:ALI BABA # 1FACILITY NUMBER:
430700017
ADMINISTRATOR:CHERALYNN SABANKAYAFACILITY TYPE:
735
ADDRESS:260 SOUTH 11TH STREETTELEPHONE:
(408) 289-1644
CITY:SAN JOSESTATE: CAZIP CODE:
95112
CAPACITY:38CENSUS: 32DATE:
08/24/2023
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Maria CanizalesTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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5
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9
Resident was not accorded dignity
Staff threatened resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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9
10
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12
13
Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding regarding the above allegation. LPA met with Program Director, Maria Canizales.

On 08/30/2022, the Department received a complaint alleging resident (R1) was not accorded dignity and staff had threatened R1. On 09/08/2022, the initial complaint investigation was conducted.

On 09/08/2022, 3 staff members were interviewed. Based on interview, 3 out of 3 staff denied yelling and threatening residents. Based on interview, staff needs to be firm with the residents but denies being rude or threatening. Staff state their intention is to educate residents on the facility’s house rules. SEE LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 26-AS-20220830145656
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: ALI BABA # 1
FACILITY NUMBER: 430700017
VISIT DATE: 08/24/2023
NARRATIVE
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On 08/23/2023, 6 residents (R1 – R6) were interviewed. 6 out of 6 residents denied staff yelling at them, calling them a liar, or threatening the residents.

On 08/23/2023, a witness (W1) was interviewed. Based on interview, R1 was going through a transitional period which may have caused stress and anxiety. W1 states the facility did not physically violate or injure R1. W1 states R1 can be very excitable and becomes upset easily. W1 states there may have been incidents where R1 said that staff had yelled or threatened him/her but couldn’t confirm whether it did or did not happen.

Due to R1’s mental health, R1 was unable to be interviewed.

R1 had moved out of the facility and to another county sometime in July 2023.

The Department has investigated the above allegations. Based on interview, observation, and record review the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegations may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Program Director, Maria Canizales and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2