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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440707795
Report Date: 02/20/2024
Date Signed: 02/20/2024 12:35:29 PM

Document Has Been Signed on 02/20/2024 12:35 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:ROLLING RIDGE R.C.H.FACILITY NUMBER:
440707795
ADMINISTRATOR:CARLONE, MICHAELFACILITY TYPE:
735
ADDRESS:751 LARKIN VALLEY ROADTELEPHONE:
(831) 475-0888
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 12CENSUS: 8DATE:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Casey ClarkTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Casey Clark, Administrator/Manager.

During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the facility kitchen area and observed there to be a perishable food supply of of at least two days and a non-perishable food supply of at least 7 days. A first aid kit was observed to be complete.

LPA Marrufo toured 6 out of 6 facility bathrooms and observed the water temperature to be between 110 F to 114 F. Each bathroom had available soap and hand drying machines. 7 out of 7 resident bedrooms were observed and each had available bedding and clothing storage as well as working lights.

LPA Marrufo tested the smoke detectors in the hallway and bedrooms as well as the carbon monoxide detector and they all functioned properly when tested.

LPA Marrufo toured the outside area and the exits were clear of obstructions.

The resident and staff records were reviewed and found to be complete. The last facility emergency disaster drill occurred on 01/16/2024.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Casey Clark and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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