445202722-9-24-2024-26-AS-KHOS-DAHP9B-20241029110651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202722
Report Date: 09/24/2024
Date Signed: 09/24/2024 03:34:02 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2024 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20240503141412

FACILITY NAME:	RACHELLE'S HOME II		FACILITY NUMBER:	445202722
ADMINISTRATOR:	RECINTO, RACHELLE		FACILITY TYPE:	740
ADDRESS:	109 BEHLER RD		TELEPHONE:	(831) 319-4465
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	12	CENSUS: 9	DATE:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rachelle Recinto		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff is accepting residents under the age of 60 without an exception.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) David Marrufo and Santino Fortes conducted an unannounced complaint investigation visit and met with Rachelle Recinto, Administrator (ADM). On 05/03/2024, the Department received a complaint with the above allegation. On 05/10/2024, LPA Marrufo conducted an initial complaint investigation visit and observed residents and obtained copies of resident records.

Review of resident records indicate that residents R1-R11 are admitted residents at the facility. Residents R2, R3, and R6 were under the age of 60 during the visit on 05/10/2024. Residents R1, R4, R5, and R7-11 were aged 60 years old or over during the visit on 05/10/2024.

See LIC9099-C for more information. Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 26-AS-20240503141412

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: RACHELLE'S HOME II	FACILITY NUMBER: 445202722
	VISIT DATE: 09/24/2024

NARRATIVE

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Resident R2 has a Primary Diagnosis of Dementia, is not able to transfer from bed, and is non-ambulatory. R3 has a Primary Diagnosis of Down’s Syndrome and a Secondary Diagnosis of Alzheimer’s disease. R6 has a Primary Diagnosis of Degenerative Disease of Nervous System and Kidney Disease and is on hospice.

Residents R5, R7, R8, and R11 have a primary diagnosis of Dementia. R1 and R10 are not able to transfer from bed. R1 and R10 are non-ambulatory. R7 has a diagnosis of Down’s Syndrome. R11 has Alzheimer’s disease. R7 is on hospice.

LPA Marrufo reviewed the Appraisal/Needs and Services Plans for Residents R1-R11. LPA Marrufo did not observe any different requirements for care and supervision in the Appraisal/Needs and Services Plans in resident R2, R3, and R6 compared to the Appraisal/Needs and Services Plans of the rest of the residents.

During visit on 09/24/2024, LPA Marrufo interviewed staff S1-S4 and ADM, who all stated that residents receive the same level of care. ADM stated during interview that ADM does not accept prospective residents under 60 years old if they do not have the same level of care as the residents who are over 60 years old.

On 09/24/2024, LPA Marrufo made telephone calls to the Authorized Persons (AP) of residents R1-R11. LPA Marrufo was able to conduct telephone interviews with resident R3’s AP (AP1), resident R6’s AP (AP2), and resident R7’s AP (AP3). AP1 stated that R3 needed a much higher level of care than the other residents. AP1 stated that R3 needs pureed food, cannot eat alone, is not independent with the toilet, and is non-verbal.

After reviewing the Physician’s Reports for resident R1-R11, LPA observed that R4 is not able to care for his/her own toilet needs; R7 requires pureed food and needs support with bowel impairment and is able to communicate some words; R9 is not able to feed self; R10 is not able to care for his/her own toileting needs.

AP2 stated that R6 is currently on hospice. AP2 stated that when R6 was first admitted to the facility, R6’s level of care was the same as the other residents before R6 was put on hospice.

Page 2 of 3.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20240503141412

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: RACHELLE'S HOME II	FACILITY NUMBER: 445202722
	VISIT DATE: 09/24/2024

NARRATIVE

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AP3 stated to not know if residents under 60 years old at the facility require a different level of care than those over 60 years old.

This agency has investigated the complaint allegations listed. Based on interviews and review of records, the CCLD has found that the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

This report was reviewed with ADM Rachelle Recinto and a copy of this report was provided.

Page 3 of 3.

END REPORT

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3