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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440707795
Report Date: 02/04/2025
Date Signed: 02/21/2025 03:15:07 PM

Document Has Been Signed on 02/21/2025 03:15 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/
DIRECTOR:		CARLONE, MICHAELFACILITY TYPE:
735
ADDRESS:751 LARKIN VALLEY ROADTELEPHONE:
(831) 475-0888
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 12CENSUS: 8DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Casey ClarkTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Casey Clark.

During visit, LPA toured the facility inside and out. LPA toured the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days.

LPA toured the resident bedrooms and observed each bedroom to have working lights and available bedding and clothing storage areas. LPA tested the smoke detectors in each resident bedroom and hallways. Each smoke detector functioned properly when tested. LPA tested two out of two carbon monoxide detectors and both functioned properly when tested. LPA toured the outside area and observed the exits to be clear of obstructions.

LPA toured six out of six bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperature in the bathrooms sinks was between 106 F to 116 F.

LPA reviewed 5 out of 5 resident records, including Centrally Stored Medication and Destruction Records and Personal and Incidental Money Logs, and all reviewed records were complete. LPA reviewed 5 out of 5 staff records and all staff records were complete.

The last recorded emergency disaster drill was conducted on 01/15/2025.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Casey Clark and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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