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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201914
Report Date: 04/04/2023
Date Signed: 04/04/2023 10:49:21 AM

Substantiated


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
03/16/2023 and conducted by Evaluator Christine Dolores
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20230316160848
FACILITY NAME:LIFE SERVICES ALTERNATIVES INC - SB 962 HOME #1FACILITY NUMBER:
435201914
ADMINISTRATOR:LANSANA, JOSEPHFACILITY TYPE:
734
ADDRESS:1320 S BAYWOOD AVETELEPHONE:
(408) 982-5625
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY:5CENSUS: 4DATE:
04/04/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Joseph LansanaTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Facility does not have RN or LVN on duty
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Christine Dolores arrived unannounced to deliver the finding for the above allegation. LPA met with Administrator, Joseph Lansana.

On 03/16/2023, the Department received the complaint. On 03/22/2023, the initial complaint investigation was conducted. Documents were obtained to include the facility’s 24-hour staffing report from February – March 2023 and monthly schedule from 01/22/2023 – 04/15/2023.

On 03/16/2023, LPA interviewed 2 staff members. Based on interview, the facility has Licensed Vocational Nurses (LVNs) on duty every shift but does not have a permanent Registered Nurse (RN) for the facility. In the meantime, the facility shares RNs from another facility managed by the Administrator. This has been ongoing since January 2023. The facility would have a RN on duty for some days and be on-call for the remainder of the week. SEE LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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 3
Control Number 26-AS-20230316160848
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: LIFE SERVICES ALTERNATIVES INC - SB 962 HOME #1
FACILITY NUMBER: 435201914
VISIT DATE: 04/04/2023
NARRATIVE
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Based on record review, the facility has 5 residents, therefore are required to have 40 hours of RN coverage per week. The review of the RN schedule did not show the facility was meeting the required RN hours per week. The review of the monthly schedule and 24-hour staffing report shows a LVN or Licensed Psychiatric Technicians (LPT) on duty for every shift.

The Department has investigated the above allegation and the preponderance of evidence standard has been met, therefore, the Department found the above allegation to be SUBSTANTIATED. A deficiency is being cited per California Code of Regulations, Title 22. See LIC9099-D.

A plan of correction was developed with Administrator, Joseph Lansana and a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20230316160848
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: LIFE SERVICES ALTERNATIVES INC - SB 962 HOME #1
FACILITY NUMBER: 435201914
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2023
Section Cited
CCR
80065(a)
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(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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Licensee will continue to work on maintaining a RN at the home for the number of hours required per resident, per week. Licensee will submit their RN staffing plan for April 2023 to LPA by POC due date.
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Based on interview, record review, and observation the Licensee did not ensure to meet the required RN hours per week which poses an immediate health, safety, and personal rights risk to persons in care.
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If there are changes in the RN schedule in which they are not able to meet the required RN hours per week, Licensee will notify the Department.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3