445202722-11-23-2024-26-AS-KHOS-DBCPE2-20241125101424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202722
Report Date: 11/23/2024
Date Signed: 11/23/2024 12:27:47 PM

Unsubstantiated

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
03/03/2021 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 26-AS-20210303162449

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: 8	DATE:	11/23/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Office manager - Yuly Arita		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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- Facility did not have a care plan in place to address resident's needs
- Facility staff not trained to care for resident's needs

INVESTIGATION FINDINGS:

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On 11/23/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannouced complaint investigation visit in order to deliver findings regarding the allegations recieved. LPA met with office manager Yuly Arita and explained the purpose of today's visit.

Per documentation reviewed, interviews conducted by previous LPA, and LPA Vado's interview with the licensee Rachelle Racinto. Documentation was received from the hospital showing that the resident's wound was a stage 2 on 3/1/2021 and was discharged to the facility. On 3/2/2021 a home health nurse came to the facility to provide care to the resident. The home health nurse found the wound to be a stage 4. It was at this time the facility and medical team of the resident arranged to have the resident sent to a skilled nursing facility due to the stage 4 so the resident can receive the care needed for recovery. The resident never returned to the facility and is not present at the facility on this day. These allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

No citations issued. Report is reviewed with Yuly and a copy is provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2024

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

LIC9099 (FAS) - (06/04)

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