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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202597
Report Date: 07/09/2021
Date Signed: 07/09/2021 02:32:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 43DATE:
07/09/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Steven SilacciTIME COMPLETED:
02:30 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. Also present during the meeting was Erik Cintoa, Memory Care Program Manager.

At 11:05 AM LPA conducted a tour of the facility, LPA observed caregiver assisting resident after an unwitnessed fall. LPA observed caregiver assessing the resident and reporting the fall to his/her supervisor. Supervisor determined that emergency services needed to be called to further assess wound on resident's head. Emergency services arrived at approximately 11:15 AM. LPA observed the facility calling resident's family member and overheard paramedic determining that resident did not need to go to hospital. LPA observed resident fall and assessment protocol being followed properly.

LPA conducted interviews with 3 caregivers. When asked to describe resident assessment and facility reporting guidelines, all 3 staff provided answers that were reflective of facility's compliance plan.

LPA reviewed staff training records, which were noted to be in compliance with facility's compliance plan.

Exit interview conducted with Executive Director. 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: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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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