430707831-3-28-2024-26-AS-KHOS-D3XH7C-20240402055632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430707831
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:07:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2021 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20211012103624

FACILITY NAME:	LITTERAL HOUSE		FACILITY NUMBER:	430707831
ADMINISTRATOR:	ZACHARY KASOW		FACILITY TYPE:	772
ADDRESS:	96 SOUTH 14TH STREET		TELEPHONE:	(408) 998-3293
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	14	CENSUS: 14	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Christina Rossi		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Clients are not allowed visitors while in care

INVESTIGATION FINDINGS:

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On 3/28/2024, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint inspection. LPA met with Administrator Christina Rossi and explained the purpose of the visit.

During the visit, LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.

On 10/12/2021, the Department received a report alleging that clients are not allowed visitors while in care.

The Department conducted interviews and record reviews. Based on the information available, it was unable to prove whether the clients were not allowed visitors while in care.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation is unsubstantiated, at this time.

An exit interview was conducted, and a copy of this report dated is provided.

No deficiencies were cited during the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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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