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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202722
Report Date: 08/22/2024
Date Signed: 08/22/2024 06:27:44 PM


Document Has Been Signed on 08/22/2024 06:27 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:RACHELLE'S HOME IIFACILITY NUMBER:
445202722
ADMINISTRATOR:RECINTO, RACHELLEFACILITY TYPE:
740
ADDRESS:109 BEHLER RDTELEPHONE:
(831) 319-4465
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:12CENSUS: 9DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rachelle RecintoTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Rachelle Recinto.

During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed locked storage areas for cleaning supplies and sharp objects. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. The first aid kit was observed and found to be complete.

LPA toured the outdoor area and found the exits to be clear of obstructions. LPA toured 7 out of 7 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as working lights. LPA tested the hallway carbon monoxide detector and found it to function properly when tested. The facility has a centrally connected smoke detector system. The smoke detector system was tested and found to function properly when tested.

LPA toured two out of two resident hallway bathrooms. Each bathroom had working lights and available soap and paper towels. The showers had grab bars, shower chairs, and anti-slip mats. The water temperatures in the bathroom sinks were measured at 119 F.

LPA reviewed 5 resident files and 5 staff files and found them to be complete.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Rachelle Recinto and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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