<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435201914
Report Date: 05/02/2024
Date Signed: 06/14/2024 11:41:59 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
04/26/2024 and conducted by Evaluator Christine Dolores
COMPLAINT CONTROL NUMBER: 26-AS-20240426091105
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:
05/02/2024
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Africa GarlejoTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff was drinking an alcoholic beverage in the facility during lunch
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS IS AN AMENDED REPORT FROM COMPLAINT VISIT ON 05/02/2024. On 05/02/2024, Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation. LPA met with desginated Adminsitrator, Africa Garlejo.

On 04/26/2024, the Department received the complaint regarding the above allegation. On 05/02/2024, the intial complaint investigation was conducted.

The following documents were obtained for this investigation to include a staff schedule for April 14, 2024 - May 11, 2024, 4 out of 4 resident face sheets, incident reports, and email correspondences.

SEE LIC9099-C for additional information.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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 2
Control Number 26-AS-20240426091105
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: 05/02/2024
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
26
27
28
29
30
31
32
On 04/24/2024, a nurse from another Department arrived to the facility and observed an alcoholic beverage sitting on top of a table. It was alleged a staff member was drinking the beverage in the facility during lunch time.

On 05/02/2024, 4 staff members were interviewed. Based on interview, on 04/26/2024 staff (S1) had quickly grabbed the beverage from his/her home refrigerator without knowing it contained alcohol. The beverage was purchased by his/her family member. S1 did not read the can prior to consumption and thought the beverage was only sparkling water with pineapple. Around 1:00pm, S1 took his/her lunch in the facility and drank the beverage. S1 thought the beverage tasted bad, dumped the remainder of the liquid down the sink, and left the can on top of a table in the facility. Around 1:00pm, the nurse from another Department arrived to the facility for a visit. After S1's lunch, he/she placed the can inside his/her lunch bag. S1 ended work around 2:30pm - 2:45pm and denied any altered mental status after the consumption of the beverage.

After staff (S2) was informed of the incident, S1 was called into the office. S2 states S1 was observed to look normal during their meeting. S1 was suspended from work the same day, following further investigation. Based on the facility's investigation, S2 stated the incident did happened, however, believes it was unintentional and an accident as S1 did not know the drink contained alcohol. S1 returned to work on 05/01/2024. Following the incident, the facility plans to provide training to staff regarding the company's policies regarding drugs and alcohol use during working hours.

S3 states this was the first time this has happened and denied the observation of S1 drinking alcohol in the facility on other days. Based on interviews, the residents were not impacted from this incident and observed to be well.

The Department has investigated the above allegation. Based on interview, record review, and observation the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator, Joseph Lansana and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2