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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202841
Report Date: 01/29/2025
Date Signed: 01/29/2025 01:48:17 PM

Document Has Been Signed on 01/29/2025 01:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HATIKVAH HOUSEFACILITY NUMBER:
435202841
ADMINISTRATOR/
DIRECTOR:		JUSTIN WILLIAMSFACILITY TYPE:
735
ADDRESS:577 NORTH CENTRAL AVENUETELEPHONE:
(408) 727-3493
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 6CENSUS: 6DATE:
01/29/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Staff 2 (S2), Nikha Shane Navarro, Direct Supportive ProfessionalTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On January 29, 2025 at 1:35 PM, Licensing Program Analysts (LPAs) Kenneth Madrigal and Simi Rai arrived at the facility unannounced to conduct a case management – other visit. LPAs met with Staff (S2), Nikha Shane Navarro, Direct Supportive Professional. LPAs observed one staff member and one resident during the visit. Five out of the six residents are at day program during the time of the visit.

LPAs spoke on the phone at 1:36 PM with Felicia Lehner, Program Manager (PM) and stated the purpose of today's visit. PM was unable to meet with LPAs during today's visit and verbally gave permission for staff (S2) to sign today's report on her behalf.

The purpose of the visit is to hand deliver an immediate exclusion letter for an individual (S1) who the Department determined engaged in conduct inimical as a staff in the facility. LPAs sealed the letter and handed it to S2 with Program Manager, Felicia Lehner's verbal permission. PM states S1 was never hired, does not work for the facility, is not in their Human Resources (HR) system. Additionally, PM stated she will separate S1 from the facility roster and Guardian and that S1 was terminated in 2023.

PM will submit an updated LIC 500 to the Department via email.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Staff (S2), Nikha Shane Navarro and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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