430701476-10-30-2024-26-AS-KHOS-DARKDR-20241106064911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430701476
Report Date: 10/30/2024
Date Signed: 10/30/2024 10:50:48 AM

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
05/16/2024 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20240516154641

FACILITY NAME:	ALI BABA # 2		FACILITY NUMBER:	430701476
ADMINISTRATOR:	CHERALYNN SABANKAYA		FACILITY TYPE:	735
ADDRESS:	268 SOUTH 11TH STREET		TELEPHONE:	(408) 289-1644
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	26	CENSUS: 6	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Program Director - Maria Canizales		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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- Staff threw away resident's saved food
- Staff is forcing resident to make a medical appointment

INVESTIGATION FINDINGS:

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On 10/30/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the allegations received. LPA met with program director Maria Canizales and case amanger Susana Toyar and explained the purpose of today's visit.

During the investiation interviews were conducted and observations were made. Based on the interviews conducted, and the information reviewed from those interviews, there is conflicting accounts for what happened between the facility and complainant. Regarding food storage, it is not allowed in the kitchen refrigerator, and staff interviewed do not recall coffee being stored then thrown away. It is facility policy to not allow resident food storage as a rule. Regarding forcing resident to make a medical appointment, staff are not forcing the resident, but rather the resident is refusing to be seen to refill medications and basic health and psych check. Based off of interviews conducted as part of this investigation, LPA cannot prove or disprove that the allegations took place as described. These allegations are unsubstantiated.

Based on these observations, the above allegations are 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.

Report is reviewed with Maria Canizales and a copy is provided on this day.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cara Smith
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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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