435202511-1-15-2024-26-AS-KHOS-CZJHZJ-20240116053823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202511
Report Date: 01/03/2024
Date Signed: 01/15/2024 01:04:26 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
11/17/2020 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20201117160300

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: 24	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Maria Canizales		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff withheld resident's mail.
Resident is not allowed to receive an assessment.
Staff bribed resident.

INVESTIGATION FINDINGS:

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Amended report on 1/11/24
On 1/03/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegations. LPA met with Program Director (PD) Maria Canizales and explained the purpose of today's visit.

Regarding the allegation of staff withheld resident’s mail, reporting party (RP) mentioned that the staff, at the owner's direction, allegedly intercepted and refused to deliver mail to clients/residents.

During two facility visits by LPA Marrufo & LPA Donato on 11/30/2020 and 1/03/2024, six residents were interviewed collectively. Five out of six residents confirmed that they were able to receive their mail, and nothing was withheld from them. One resident (R1) stated that he/she ordered a beanie that came through USPS and opened the package in front of the staff. Another resident (R2) doesn’t remember anymore as it has been three years since.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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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Control Number 26-AS-20201117160300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CLUB RIVIERA	FACILITY NUMBER: 435202511
	VISIT DATE: 01/03/2024

NARRATIVE

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cont. of Amended report on 1/11/24

Regarding the allegation of resident not allowed to receive assessments, RP stated that the staff, at the owner's direction, allegedly refused to allow Behavioral Health Services Department (BHSD) staff access to clients/residents so that they could interview and perform assessments to determine appropriate levels of care.

Based on interviews, five out of six residents mentioned that staff have not kept them from having assessments and they were able to get assessments during this time. R1 said that staff has been good to them. LPA Marrufo interviewed a witness (W1) that mentioned they were not physically held by facility staff from helping their residents and they didn’t find any issues with regards to client assessments.

Regarding the allegation of staff bribed a resident, RP stated that the owner allegedly paid, or offered to pay, at least one client to convince them to refuse to accept a transition and to stay at one of his facilities.

Based on an interview with a rehab counselor (C1), there was a resident (R3) that the facility was paying to do chores at the facility. Six out of six residents interviewed stated that they haven’t been bribed by staff members.

Based on observation and interviews, the department has determined that these allegations were UNSUBSTANTIATED, meaning that 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.

The report was reviewed, and a copy is provided.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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