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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445294215
Report Date: 06/27/2022
Date Signed: 07/01/2022 09:31:45 AM


Document Has Been Signed on 07/01/2022 09:31 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:SOQUEL LEISURE VILLA, INC.FACILITY NUMBER:
445294215
ADMINISTRATOR:SATO, RENE & HAYDEEFACILITY TYPE:
740
ADDRESS:4101 FAIRWAY DRIVETELEPHONE:
(831) 462-4101
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY:30CENSUS: 17DATE:
06/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Haydee SatoTIME COMPLETED:
11:30 AM
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The Department conducted a case management tele-visit regarding the facility's ongoing financial struggles and intent of closure. The meeting was attended by Regional Manager Vivien Helbling (RM), Licensing Program Manager Romeo Manzano (LPM), Licensing Program Analyst Ryker Heberle (LPA), Facility Administrator Haydee Sato (Admin), Administrator of Rachelle House Rachelle Recinto (W1), Facility Bookkeeper Kavita Pandya (W2), Santa Cruz Long Term Care Ombudsmen Sarah Eddings and Steven Matzie (LTCOs), and State Long Term Care Ombudsman Jill Hernandez (SLTCO).

During the meeting W1 announced that her and Admin had come to an agreement that W1's corporation would be taking over ownership of Soquel Leisure Villa. W1 stated that they are currently working on submitting the paperwork for an official change in ownership, but that W1 would be taking over finances, staffing, and operations effective July 1st, 2022. Admin stated that she would be responsible for payment and staffing until July 1st/ Admin stated that she agreed to this course of action. RM reminded Admin that the facility will still fall under her license until the paper work is complete, and that she will therefore be liable until the new license takes effect. Admin said she understood.

The Department reminded Admin and W1 that the facility needs to draft a formal letter to licensing, facility residents, and responsible parties indicating change of ownership. The Department requested a facility staffing plan for how staffing will be maintained until the end of the week and into the future after W1's takeover. The Department also requested the operations agreement, which shall include the responsibility of the licensee and shall designate responsibilities during the interim period before the new license takes effect. W1 stated that she should have the drafted letter and staffing plan available to The Department by the end of the day today. W1 and Admin to maintain contact with The Department and LTCOs as the situation continues developing. This report was delivered electronically for signature
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
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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