430701476-1-29-2025-26-AS-KHOS-DFTKGV-20250417075409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430701476
Report Date: 01/29/2025
Date Signed: 01/29/2025 11:58:43 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
05/21/2024 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20240521143353

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: 32	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Prunella Cardozo		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff are harassing resident
Staff are inappropriately asking other residents questions about resident
Staff are falsly documenting things about resident

INVESTIGATION FINDINGS:

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On 1/29/2025 Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit at the facility. LPA met with Prunella Cardozo and explained the purpose of the visit.

Regarding the allegation Staff are harassing resident, reporting party (RP) stated that facilities case manager is constantly harassing R1. R1 stated that the case manager is always yelling at him/her and knocking on his/her door.

LPA Dolores interviewed five residents including R1. R2 shared that he/she thinks the facility is good and likes it. The staff are great and talk to him/her with respect. R3 mentioned h Ne/she has no problem with staff, they're cool and they're down to earth. No one ever harassed R3. R4 said that the staff here are good. How do they treat other residents, R4 can't really say. Feels safe around staff. R5 shared that the staff some of them are okay and some are not. No threatening or harassing.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
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.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20240521143353

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 # 2	FACILITY NUMBER: 430701476
	VISIT DATE: 01/29/2025

NARRATIVE

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LPA was also able to interview six staff members. S1 mentioned that R1 follows S1 around then accused of harassing R1. S1 doesn't approach R1 without a witness because of how R1 is. S1 denied harassing R1. S2 denied S1 harassing R1, states R1 accuses S1 of following her around when Sandra is following Susana around. S3, S2, and S1 states they try not to interact with R1 unless it's needed for his/her care. They let R1 be. Even for housekeeping there has to be 2 of them for witness. S5 shared that S1 likes to intimidate a lot. The resident say S1 intimidate him/her. For example, when he/she was doing case management a resident said can you take me not to S1 because S1 wouldn't help with what he/she was doing and they felt lost with S1 at appointments. S6 shared how S1 talks to clients. S1 would joke around with them if he/she knows them well. But overall S1's nice to the clients and respect them. If they do something, S1 will tell them not to do that in the facility. S1 wouldn't yell at them. Haven't seen S1 harass R1.

Regarding the allegation of Staff are inappropriately asking other residents questions about resident, RP stated that the case manager was asking other residents “What R1 is like?”

R1 has shared that he/she's friends with R2 and S1 went up to R2 asking how R1 is like, how is R1 is doing.

According to the interviews, R2 stated that the staff hasn't talked about R1 about him/her before. R3 said that staff don't talk to him/her about other residents. R4 shared that they haven't talked about other residents with him/her. No questions about how other residents are doing. S3 states clients talk. Sometimes he/she does ask how other clients are doing. Like for example, they ask general questions like hey what's going on, are there any concerns then they will speak out. Some of the clients say they saw whatever they see.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
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

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20240521143353

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 # 2	FACILITY NUMBER: 430701476
	VISIT DATE: 01/29/2025

NARRATIVE

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Regarding the allegation of Staff are falsely documenting things about resident, RP sated that the case manager even wrote down that R1 doesn’t have anxiety when he/she smokes around people, which RP says isn’t true.

During the interviews, R1 shared that S1 is saying he/she has gotten upset when they throw away rotten food - not true. It's an email to the case manager. S1 said there's 60 clients and it's too much work to store 60 client foods. He/She brought up the smoking and eating in front of people. According to S3, R1 was smoking in the front but it's not a smoking area. Now they had to put a sign because the other clients started smoking at the front. States that residents can put food in the refrigerator and R1 can also put food inside the refrigerator when requested. They stopped storing food at Club (sister facility) because R1's letting the food rot. R1 hasn't requested to leave food here. If he/she were to ask, R1 can store food here. They store all their food inside the general refrigerator.

Additionally, R3 &R5 shared they don’t falsify documents, they know better. R4 doesn’t think any information is falsified. S5 and S6 also said that there’s no falsifying of documents.

Based on records review, in R1s needs and services plan, part of R1s assessment is that R1 has poor insight to his/her mental health and accuses others’ behaviors for his/her attitude and emotional outbursts and difficult time adjusting to facility procedures and rules and continues to experience emotional outbursts towards staff when redirected. R1 refused to sign the assessment.

Based on interviews and records review, the department has determined 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, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
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

LIC9099 (FAS) - (06/04)

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