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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202722
Report Date: 10/01/2025
Date Signed: 10/01/2025 03:57:06 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
08/26/2025 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20250826154715
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: 8DATE:
10/01/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tyrone VegaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident sustained unexplained fracture
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Tyrone Vega. On 08/26/2025, the department received a complaint with the above allegation. On 08/27/2025, LPA Marcella Tarin conducted an initial complaint investigation visit.

On 09/12/2025, department investigators obtained copies of R1’s medical and hospital records. R1’s medical and hospital records indicate that on 08/01/2025, R1 was seen at the hospital for right knee pain following a twisting motion in bed two days prior. The medical records indicate R1’s right knee x-ray showed no evidence of a fracture. Department investigators reviewed R1’s hospital records and found no indication R1’s hospital visit was due to staff neglect or staff failing to seek timely medical care.

See LIC9099-C page for more information. Page 1 of 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
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-20250826154715
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: 10/01/2025
NARRATIVE
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No deficiencies were cited at this time as per California Code of Regulations Title 22.

This agency has investigated the complaint allegation listed. Based on review of records, the department 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 Tyrone Vega and a copy of this report was provided.


Page 2 of 2.


END REPORT
SUPERVISORS NAME: Maria Partoza
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3