430700017-9-22-2025-26-AS-MYAZ-DLRPGW-20250922111857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430700017
Report Date: 09/22/2025
Date Signed: 09/22/2025 11:19:50 AM

Document Has Been Signed on 09/22/2025 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	CHERALYNN SABANKAYA		FACILITY TYPE:	735
ADDRESS:	260 SOUTH 11TH STREET		TELEPHONE:	(408) 289-1644
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY: 38		CENSUS: 25	DATE:	09/22/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Prunella Cardoza, Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:25 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/22/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Case Management visit to deliver findings on an investigation. LPA announced the purpose of the visit and met with Prunella Cardozo Administrator (ADM). On 07/14/25 the department received an incident report. On 07/15/25 LPA Yanez conducted a Case Management regarding the above incident report and met with ADM and obtained pertinent documents for 6 residents, staff training, facility staff roster and client roster. During the investigation 4 Staff (S1-S4) were interviewed and 5 Residents (R1-R5) were also interviewed. S1 stated that he/she does not believe there is a drug problem at the facility and when a client is caught using illegal drugs that the facility will confiscate them and any tools used to do the drugs like drug paraphernalia like wrappers or pipes and after a client is caught with drugs the staff will then council and educate them on possible repercussions. 4 out of 4 staff stated that to prevent drug use in the facility the staff diligently conduct room searches and look for any signs of substance abuse and will confiscate the drugs.

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Marcela Yanez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/22/2025

NARRATIVE

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S1stated that the facility will contact the case managers of the client and inform them of the incident and give the client a written warning. S3 stated the resident does not really care about the written warning. 4 out of 4 staff said that the facility will watch the cameras to see if any residents are grouping together because they plan on doing drugs. S2 stated that he/she has seen residents doing illegal drugs and has confiscated the drugs and followed protocol when drugs are found. S2 stated that there is a binder in the medication room that has pictures of drugs and what they look like. S2 stated that incidents of illegal drug use are documented on an incident report. S2 stated that when the clients case manager is informed of a drug use incident with a client the case manager will usually counsel the client and figure out a prevention plan. 4 out of 4 staff stated that they interact with clients and know their baseline and can tell if the client is under the influence of drugs. S4 stated that he/she can see signs of drug usage on a resident’s face if they seem tired or active, their mood, body movements and their eyes. S4 stated he/she conducts room checks and looks for drug usage and will confiscate items when found and will issue a written warning.

C2 stated that the facility tries to crack down on the drug usage at the facility and the clients are searched and sometimes they get caught and sometimes they don’t. C2 stated the facility is trying to crack down on illegal drug usage. C1 stated that the facility is good and enjoys living at the facility. C1 stated the staff does not allow drugs at the facility or allow clients to consume illegal drugs at the facility. C1 stated staff are proactive with preventing drug usage. C1 stated room searches are conducted once every week. C1 stated that if he/she does illegal drugs he/she does it off site or in the bathroom. C2 stated that he/she has no issues with the facility staff. C2 stated that the facility tries to prevent drugs from entering the facility and preventing from drug usage on facility property. C3 stated that he/she has room searches randomly every week and the staff does not search his/her person. C3 stated that the last time he/she used drugs was off property. C5 stated that he/she come to visit the facility from sister facility and will meet with clients from the facility to do drugs and they do drugs off property.

On 08/18/25 the department completed its investigation and found the findings to be Unsubstantiated.

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 above allegations are unsubstantiated at this time.

This report was reviewed with Administrator Prunella Cardozo

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Marcela Yanez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

LIC809 (FAS) - (06/04)

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