440707568-7-14-2025-26-AS-KHOS-DK2H6M-20250729055519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 440707568
Report Date: 07/14/2025
Date Signed: 07/14/2025 12:27:09 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
07/08/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250708161434

FACILITY NAME:	FRONT STREET RESIDENTIAL CARE		FACILITY NUMBER:	440707568
ADMINISTRATOR:	KARINA MORENO		FACILITY TYPE:	735
ADDRESS:	126 FRONT STREET		TELEPHONE:	(831) 427-3387
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	47	CENSUS: 45	DATE:	07/14/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator Karina Moreno		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff do not ensure facility is in good repair
Staff do not prevent residents from smoking in non-designated areas

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced initial complaint investigation visit and met with Administrator (ADM) Karina Moreno. LPA stated the purpose of the visit.

On 7/8/2025 the Department received a complaint with the above allegations

During visit LPA Tarin interviewed 2 Staff (S1 to S2) and 10 Residents (R1 to R10).

It has been alleged that staff do not ensure the facility is in good repair, that the facility has 'old (plumbing) pipes." Based on interviews, 7 Out of 10 residents state he/she has no issues or concerns with the facility plumbing. R7 to R9 states he/she has observed issues with plumbing, such as a toilet being clogged, but facility staff addressed the issue.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

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-20250708161434

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: FRONT STREET RESIDENTIAL CARE	FACILITY NUMBER: 440707568
	VISIT DATE: 07/14/2025

NARRATIVE

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LPA interviewed 2 staff (S1 to S2). 1 Out of 2 Staff state he/she is not aware of any plumbing issues. S1 states over the holiday weekend, there were plumbing issues (clogged toilet, clogged sink) but were repaired by maintenance.

Based on review of facility maintenance log for 7/11/2025, LPA observed a service request for "toilet clogged" placed on 7/11/2025 at 11:35AM. Maintenance log states "Completed on 7/11/2025 at 12:38PM."

LPA inspected 12 toilets throughout the facility with S1. LPA observed 8 out of 10 toilets functioned properly when flushed by S1. LPA observed 2 toilets to have plumbing issues (1 toilet clogged, 1 toilet not flushing completely). During visit, facility staff fix/repaired toilets. LPA observed the 2 toilets to be functioning properly when flushed by S1.

Based on interviews, record review and observations, facility staff are repairing/fixing plumbing issues (toilets clogged) within 1 hour.

Staff do not prevent residents from smoking in non-designated areas
It has been alleged that the staff do not prevent residents from smoking in non-designated areas. LPA interviewed 10 residents. 7 Out of 10 Residents state he/she has not observed residents smoking in non-designated smoking areas. R6 states residents sometimes smoke in front of the kitchen (there is a public sidewalk located in front of kitchen). R7 states he/she has observed residents smoking in the resident courtyard area. R10 states he/she does not like when residents smoke in front of his/her room.

LPA interviewed 2 staff. 2 Out of 2 staff states he/she red-direct residents when they are smoking outside of designated smoking areas.

LPA observed residents smoking in the designated smoking area during visit.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Karina Moreno, and a copy of this report was provided.

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SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

LIC9099 (FAS) - (06/04)

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