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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440707795
Report Date: 02/04/2025
Date Signed: 02/04/2025 04:22:32 PM

Document Has Been Signed on 02/04/2025 04:22 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:Case Management - Legal/Non-complianceUNANNOUNCEDTIME 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 Legal/Non-Compliance visit and met with Casey Clark.

During visit, LPA Marrufo reviewed the Abuse Training Records file. LPA observed that staff have received certifications for completed Mandated Reporting and Abuse Prevention Training during the last two months. LPA observed the staff training logs, which included report forms completed by staff in which they could indicate if they have or have not observed another staff abusing a resident. LPA reviewed the response forms and observed all the staff response forms indicated that staff have not observed another staff abusing a resident. LPA observed the staff training sign-in sheet for training conducted on 11/2024.

During visit, LPA interviewed staff and asked them if they have observed any abuse, if they have received any training on abuse, and what they would do if they observed any abuse.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was review 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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