<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202597
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:14:10 PM

Document Has Been Signed on 12/03/2024 04:14 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/
DIRECTOR:		STEVEN SILACCIFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY: 59CENSUS: 51DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Steven Silacci, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Steven Silacci. LPA toured the interior (1st and 2nd floor) and exterior of the facility with the ADM to include the resident activity areas, dining rooms, kitchen, resident bedrooms, bathrooms, and exterior. Facility temperature maintained at 72 degrees F. Facility staff are fingerprint cleared and associated to facility. All emergency exits were observed to be clear of obstruction.

LPA 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. Refrigerator temperature maintained at 35 degrees F and freezer maintained at -10 degrees F. No toxins, chemicals or items that can pose a danger to residents observed.

The facility was equipped with smoke and carbon monoxide detectors. Fire extinguishers were last serviced on 8/22/2024. LPA observed the facility first aid kit and it was observed to be complete. The facility fire/earthquake drill log was reviewed and drills are being conducted quarterly. The last fire drill was conducted on 11/25/2024. Facility has emergency disaster plan.

LPA Tarin toured 6 resident bedrooms. LPA toured 3 resident bedrooms on the 1st floor and 3 resident bedrooms on the 2nd floor. 6 out of 6 resident bedrooms had functioning lights, storage space for personal belongings, clean bedding, and a dresser/table. LPA measured hot water temperature, with a range of 108.3 to 119 degrees F for 6 out of 6 resident bathrooms.

LPA reviewed 6 residents electronic Centrally Stored Medication and Destruction Records (CSMDR). LPA observed 6 out of 6 electronic CSMDRs are complete with all medications accounted and documented. LPA observed the medication storage area was locked and inaccessible to residents in care.

See LIC809C
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
VISIT DATE: 12/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reviewed 6 out of 6 resident records. LPA observed 6 out of 6 resident records as complete to include a medical assessment, TB result, updated appraisal/needs and services plan, identification and emergency contact information, personal rights, and consent forms.

LPA reviewed 6 out of 6 staff records. LPA observed 4 out of 6 records as complete to include fingerprint clearance, health screening, TB result, personnel record, and annual training . Staff (S4) and (S5) records were observed as incomplete. S4 and S5 files did not contain current CPR/First Aid training. ADM states both S4 and S5 completed the CPR/First Aid training, but the facility did not have the documentation in S4 and S5 staff files. ADM stated he would obtain copies of the CPR/First Aid training and submit copies to LPA by 12/06/2024.

No deficiencies were cited today per California Code of Regulations, Title 22. A Technical Violation was issued. An exit interview was conducted with Administrator Steven Silacci. A copy of this report was provided.
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2