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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202099
Report Date: 12/23/2024
Date Signed: 12/23/2024 04:40:37 PM

Document Has Been Signed on 12/23/2024 04:40 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:WHEELOCK RESIDENTIAL CAREFACILITY NUMBER:
445202099
ADMINISTRATOR/
DIRECTOR:		MARIE K. ALCALAFACILITY TYPE:
735
ADDRESS:102 WHEELOCK ROADTELEPHONE:
(831) 768-0941
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 16CENSUS: 14DATE:
12/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Staff Karina Oviedo TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Marcella Tarin and Kenneth Madrigal conducted an unannounced annual inspection and met with Staff Karina Oviedo. Administrator Kathleen Alcala was unavailable for the inspection. LPAs toured the interior and exterior of the facility to include 3 buildings (labeled as 98 Wheelock, 100 & 102 Wheelock), kitchen, living room, bedrooms, community room, staff office, break room, outside patio areas and front yard. All exit passageways were free and clear of obstruction.

LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed a stand alone freezer, with client food (in the 102 Wheelock building) that did not close properly due to ice build up (picture taken). LPAs advised facility to clean the ice build up on the freezer door to ensure the door closed properly. Staff cleaned the freezer and LPAs observed that the freezer door did not close properly, with a gap measuring approximately 1/2" observed (picture taken). LPAs recorded freezer temperature -0.9 degrees F. LPAs advised facility to replace or repair freezer to ensure food safety for clients.

LPAs observed holes in the kitchen linoleum flooring, a damaged window screen (Client Room #7) and broken blinds (Client room #9), cobwebs, dusty and dirty window screens throughout the entire facility. LPAs observed damaged walls and a clogged sink in an upstairs client bathroom in 100 Wheelock (pictures taken). LPAs also observed two bathrooms without non-skid mats client bathrooms located in 100 & 102 Wheelock. LPAs advised the staff that the facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

LPAs observed the medication storage area, knives storage area, and cleaning product storage areas were locked and inaccessible to clients in care. Room temperature was at 73 degrees F, and hot water temperature was measured with a range from 111 to 118.7 degrees F.
See LIC809-C
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: WHEELOCK RESIDENTIAL CARE
FACILITY NUMBER: 445202099
VISIT DATE: 12/23/2024
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LPAs toured 16 client bedrooms. 16 out of 16 client bedrooms had a bed, dresser, functioning lights, and storage space for personal belongings.

The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by staff. Fire extinguishers were last serviced on 7/31/2024. LPAs observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake drill log was reviewed. The facility's last drill was on 6/28/2024.

LPAs reviewed records for 5 clients. 5 out of 5 client records were complete and included emergency contact information, physician's reports, needs/service plans, and personal rights.

LPAs reviewed 5 Centrally Stored Medication and Destruction Records. 5 out 5 CSMDRs were observed to be complete with all medications documented.

LPAs were unable to review staff records and client's P&I records. Staff stated that staff files were in a locked office and staff did not have the key to access the room. Staff stated only the Administrator has the key to the office, where the staff records and client's P&I records are stored. LPAs advised the facility that all personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Staff stated the facility would provide copies of staff records to the Department by 12/27/2024.

Deficiencies were cited during today's visit per California Code of Regulations Title 22. A Technical Violation was also issued. See LIC9102 for more information. An exit interview was conducted with Staff Karina Oviedo and a signed copy of this report was provided. Appeal rights were also provided.

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/23/2024 04:40 PM - It Cannot Be Edited


Created By: Marcella Tarin On 12/23/2024 at 04:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WHEELOCK RESIDENTIAL CARE
FACILITY NUMBER: 445202099

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPAs observed cobwebs, dusty dirty windows throughout facility, damaged kitchen floor, damaged bathroom walls and a clogged sink (100 Wheelock), damaged window screen (client room #7), broken blinds (client rom #9, damaged feezer which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2024
Plan of Correction
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Licensee states the facility will conduct an in-service staff training on buildings and grounds by 1/3/2025 to ensure that staff are keeping the facility clean, safe and sanitary and in good repair at all times. Licensee will submit POC by POC due date 12/24/2024.
Type A
Section Cited
CCR
80087(b)(1)
Building and Grounds
(b) All clients shall be protected against hazards within the facility through provision of the following: (1) Protective devices including but not limited to nonslip material on rugs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPAs observed two client bathrooms without a non-skid mats located in 100 & 102 Wheelock, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/24/2024
Plan of Correction
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Licensee states the facility will conduct an in-service training to include topics to include protective devices bathroom non-skids rugs to ensure the safety of clients in care. Licensee will submit POC by POC due date 12/24/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jin Jackie
LICENSING EVALUATOR NAME:Marcella Tarin
LICENSING EVALUATOR SIGNATURE:
DATE: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2024


LIC809 (FAS) - (06/04)
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