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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202879
Report Date: 02/25/2026
Date Signed: 02/25/2026 12:42:51 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
02/04/2026 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20260204090906
FACILITY NAME:RACHELLE'S HOME IIIFACILITY NUMBER:
445202879
ADMINISTRATOR:ILAGAN, MYLAFACILITY TYPE:
740
ADDRESS:4101 FAIRWAY DRIVETELEPHONE:
(831) 201-4785
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY:26CENSUS: 12DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Staff Rosa Robledo.TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not prevent residents from eloping from the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint visit to deliver the findings of the above allegation. LPA met with Staff S1 Rosa Robledo. LPA stated the purpose of the visit. S1 informed Licensee Rachelle Recinto via phone of the visit. Licensee authorized S1 to sign on her behalf.

On 2/4/2026 the Department received a complaint with the above allegation.

On 2/4/2026 the Department interviewed the Reporting Party (RP). RP states he/she observed on ‘five occasions’ where residents have ‘gotten out’ of the facility, onto the street. RP states within the past couple of weeks, he/she helped a female resident who had fallen on the street in front of the facility.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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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Control Number 26-AS-20260204090906
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 III
FACILITY NUMBER: 445202879
VISIT DATE: 02/25/2026
NARRATIVE
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RP states he/she helped the female resident back to the facility and a staff member was present. RP states he/she did not remember the name of the resident, or staff involved. RP was unable to provide additional information regarding this incident.

On 2/4/2026, the Department conducted a complaint investigation visit and interviewed the Licensee, 3 Staff (S1 to S3), 1 Resident (R1) and 1 Witness (W1). Licensee states she is not aware of any residents exiting the facility onto to the street at any time. 3 Out of 3 staff state he/she is not aware of any residents exiting the facility onto the street at any time.

On 2/4/2026, the Department interviewed 1 Resident (R1). R1 states he/she has never exited the facility front gate to the street.

On 2/25/2026, the Department interviewed Resident R2. R2 states he/she has never seen a resident outside of the facility front gate on the street.

On 2/4/2026 the Department interviewed Witness 1 (W1). W1 states he/she has observed residents exit out the facility gate and saw a resident walking up and down the street. W1 did not provide additional information regarding this incident.

On 2/5/2026 the Department reviewed Incident Report submitted to the Department from July 2025 to February 4, 2026, no incidents of reported elopements (residents exiting the facility front gate onto the street) were noted.

On 2/5/2026 the Department reviewed Santa Cruz County Sheriff’s Office Daily Press Log report from 1/16/2026 to 1/31/2026 with no reported incidents for the facility address.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited during today's visit per California Code of Regulations. An exit interview was conducted with S1 Rosa Robledo and a copy of this report was provided.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
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