435202511-9-29-2023-26-AS-KHOS-CXZVMH-20231128153336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202511
Report Date: 09/29/2023
Date Signed: 09/29/2023 04:14:26 PM

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
06/07/2023 and conducted by Evaluator Christine Dolores

COMPLAINT CONTROL NUMBER: 26-AS-20230607160711

FACILITY NAME:	CLUB RIVIERA		FACILITY NUMBER:	435202511
ADMINISTRATOR:	MUSTAFA SABANKAYA		FACILITY TYPE:	735
ADDRESS:	171 SOUTH 11TH STREET		TELEPHONE:	(408) 289-1644
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	49	CENSUS: 26	DATE:	09/29/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Maria Canizales		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff are unable to effectively communicate with residents
Staff are caring for residents while sick
Staff do not ensure resident needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding on the above complaint allegation: LPA met with Program Director (PD), Maria Canizales.

On 06/07/2023, the Department received the complaint regarding the above allegations. On 06/08/2023, the initial complaint investigation was conducted.

On 06/08/2023, 3 staff members were interviewed. Based on interview, staff (S1) states the facility has housekeeping staff whose first language is not English. The housekeeping staff understands English however, sometimes they have difficulty in speaking the language. The staff will use Google Translate, if needed to communicate with the residents. The staff can also walkie talkie an English-speaking staff to provide translation and communication, if needed. SEE LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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-20230607160711

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: CLUB RIVIERA	FACILITY NUMBER: 435202511
	VISIT DATE: 09/29/2023

NARRATIVE

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Staff (S1) – (S3) state the staff are encouraged to stay home if they are sick and not feeling well. The staff are still required to wear a face mask at work.

It was alleged that the staff do not ensure residents needs are being met, however, there was not enough information provided by the complainant on what types of needs were not being met.

On 09/29/2023, 5 residents (R1 – R5) were interviewed. Based on interview, 5 out of 5 residents state the staff treat them well at the facility. 5 out of 5 residents state they are able to communicate with all the staff. 5 out of 5 residents denied the observation of staff coming into work while sick. 5 out of 5 residents state their needs are being met at the facility.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unsubstantiated. An unsubstantiated finding indicates that although the allegations may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Program Director, Maria Canizales and a copy of the report was provided.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

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