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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202597
Report Date: 08/18/2022
Date Signed: 08/18/2022 04:19:08 PM


Document Has Been Signed on 08/18/2022 04:19 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:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:STEVEN SILACCIFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: DATE:
08/18/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Ryker Heberle conducted a Case Management - Legal/Non-compliance inspection visit to ensure that facility is adhering to the Compliance Plan submitted to Community Care Licensing Division (CCLD) after a Non-Compliance Conference held on 03/08/2021. LPA met with Executive Director Steven Silacci.

LPA conducted interviews with 3 direct care staff members. When asked to describe resident assessment and facility reporting guidelines, all 3 staff provided answers that were reflective of facility's compliance plan. All 3 staff members indicated that they thought that facility training was substantive. LPA reviewed staff training records, which were noted to be in compliance with facility's compliance plan. All care staff interviewed indicated that they had observed resident fall and assessment protocol being followed properly. All 3 care staff repeated the fall assessment protocol properly.

LPA observed 4 caregivers providing direct care to residents within the facility. No residents observed to have any injuries. care staff was observed taking residents on walks, providing activities, providing 1 on 1 social interaction, and assisting residents with leaving the facility. 2 additional care staff seen observing residents in activity areas.

No deficiencies cited during this inspection. Exit interview conducted with Executive Director Steven Silacci. A copy of this report was provided for signature.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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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