Rachelle's Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Assistant Administrator Tyrone Vega. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen and pantry areas. LPA Marrufo observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least three days. LPA toured four out of four resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks ranged from 107 F to 115 F. LPA toured 7 out of 7 resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. During visit, facility staff triggered the smoke detector and it functioned properly when tested. LPA tested the carbon monoxide detector and it functioned properly when tested. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed the first aid kit and found it to be complete. LPA reviewed eight out of eight resident records, including Centrally Stored Medication and Destruction Records and found them to be complete. LPA reviewed 6 out of 6 Personal and Incidental Money Logs and found them to be balanced. LPA reviewed five staff records and found them to be complete. The Emergency Disaster Drill Log indicates the last fire drill was conducted on 07/09/2026. See LIC809-C page for more information. Page 1 of 2. LPA Marrufo requests that the following facility records be updated and copies sent to the Department by 08/11/2026: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility LIC400 Affidavit Regarding Client/Resident Cash Resources Liability Insurance LIC610 Emergency Disaster Plan No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Assistant Administrator Tyrone Vega and a copy of this report was provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Aug 4, 2026

Allegation investigated: Staff left resident soiled for an extended period of time Staff did not ensure resident was dressed appropriately Staff are not providing adequate supervision to residents resulting in inappropriate interaction

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 following allegations. On 08/27/2025, LPA Marcella Tarin conducted an initial complaint investigation visit. LPA Marrufo conducted an additional visit on 10/01/2025. The department obtained a copy of resident R1’s Physician’s Report and Appraisal/Needs and Services Plan on 08/27/2025. R1’s Physician’s Report was completed on 02/04/2025. R1’s Physician’s Report states R1 does not have bowel or bladder impairment, does have motor impairment/paralysis, is able to dress/groom self, is able to feed self, and is able to care for own toileting needs. R1’s Physician’s Report states R1 can transfer to and from bed and is non-ambulatory. See LIC9099-C pages for more information. Page 1 of 4. Unsubstantiated R1’s Appraisal/Needs and Services Plan states “[R1] wears depends, sometimes knows when to use the toilet, [He/She] needs assistance with [his/her] ADLs (Activities of Daily Living) in all times.” On 08/27/2025, the department obtained copies of the facility weekly staff schedules from 07/28/2025 to 08/31/2025. The staff schedules indicate there are at least four staff scheduled each day from 6:00 AM to 6:00 PM, at least three staff scheduled from 6:00 PM to 10:00 PM and one staff scheduled from 11:00 PM to 5:00 AM. Allegation: Staff left resident soiled for an extended period of time During visit on 10/01/2025, LPA Marrufo attempted to interview R1, but R1 refused to be interviewed. On 10/01/2025, LPA Marrufo interviewed witness W1. W1 stated during interview that W1 visits R1 at least once per week. W1 stated to visit R1 for at least three hours at a time. W1 stated to have not observed R1 left soiled for an extended period of time. W1 stated W1 states R1 is sometimes soiled when W1 arrives at the facility to visit R1. W1 stated R1 sometimes resists staff assisting R1 with changing clothes. W1 stated R1 sometimes puts on his/her diapers incorrectly so that the diaper padding is on R1’s stomach. W1 stated R1 does have rashes which W1 believes is from urine contact. During visit on 10/01/2025, LPA Marrufo interviewed staff S1-S6. S1-S3 stated to have not observed R1 left soiled for an extended period of time. S1-S3 stated that staff change R1 every one and a half to two hours. S4 stated to not have observed R1 soiled for an extended period of time. S5 stated R1 prefers to go to the bathroom by himself/herself. S5 stated that R1 has been offered to use a portable chair in the bathroom, but R1 has denied the offer. S5 stated that staff have put padding on R1’s wheelchair and staff clean R1’s wheelchair if it is soaked with urine. S6 stated to have not observed R1 left soiled for an extended period of time. S6 stated staff is always helping R1 go to the bathroom and S6 reminds staff to check if R1 is soaked every one and a half to two hours. Page 2 of 4. On 10/01/2025, LPA Marrufo interviewed witness W2. W2 stated to have visited R1 at the facility to conduct a wellness check on R1 to check on R1’s swollen foot. W2 stated to have observed R1 soaked in urine in R1’s wheelchair. W2 stated there were two staff at the facility and 5-6 residents. W2 stated one of the staff was in the kitchen during W2’s visit. W2 stated to have told one of the staff that R1 was soaked in urine and the staff handed W2 a diaper. W2 stated to not know the name of the staff or remember what the staff looked like. W2 stated to have taken the diaper from the staff and took R1 to the bathroom. W2 stated to have helped R1 change into the diaper in the bathroom. W2 did not provide a date when W2 visited the facility to conduct a wellness check on R1. LPA Marrufo conducted an additional interview with W2 on 10/30/2025, and W2 stated to not be able to recall the date that W2 visited R1 to conduct a wellness check. Allegation: Staff did not ensure resident was dressed appropriately - Unsubstantiated During interview on 10/01/2025, W1 stated to have never observed R1 dressed in only a diaper and shirt. During interview on 10/01/2025, W2 stated to have observed R1 in only a shirt and diapers. W2 stated to not have a photograph of R1 wearing only a shirt and diapers. During interview on 10/01/2025, S1-S6 stated to have never observed R1 dressed in only diapers and a shirt. Allegation: Staff are not providing adequate supervision to residents resulting in inappropriate interaction - Unsubstantiated During interview on 10/01/2025, W1 stated that R1 has a close friendship with R2. W1 stated R1 will sometimes verbally encourage R2 to take a shower. W1 stated R1 has told W1 that R1 will sometimes be in R2’s bedroom, but not in the bathroom with R2 when R2 is in the shower. R2’s shower is inside R2’s bedroom. W1 stated R1 told W1 that R1 will sometimes pick out clothes for R2 and get a towel for R2. W1 stated R1 is not giving a shower to R2. W1 stated to have never observed R1 in the shower with R2. Page 3 of 4. During interview on 10/01/2025, W2 stated that R1 told W2 that R2 provides baths for another resident. During visit on 10/01/2025, LPA Marrufo interviewed staff S1-S6. S1 stated R1 does not assist R2 with bathing at all. S2 stated R1 does not assist R2 with showering at all and is not in R2’s bedroom while R2 is showering. S2 stated R1 does not assist with getting a towel for R2. S3 stated R1 does not assist R2 with showers at all and staff provide R2 with towels. S4 stated R1 does not provide any assistance with showering R2. S5 stated to have not observed R1 shower R2. S6 stated R1 does not provide showers for R2. During visit on 10/01/2025, LPA Marrufo interviewed R2 at the facility while R2’s conservator was listening to the interview via telephone call with the speakerphone activated. During interview, R2 stated staff assist R2 with taking showers. R2 stated R2 takes showers alone and no one is in the shower with R2. R2 stated R1 turns the shower knob for R2. R2’s conservator stated that R2 can sometimes make exaggerated statements. LPA Marrufo asked R2 again if anyone turns the shower knobs for R2 and R2 said no. Based on information from interviews conducted with staff, residents, and witnesses, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Tyrone Vega and a copy of this report was provided. Page 4 of 4. END REPORTthe state’s words, verbatim · CDSS document, Oct 30, 2025 · control 26-AS-20250826154715

Allegation investigated: Resident sustained unexplained fracture

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 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 REPORTthe state’s words, verbatim · CDSS document, Oct 1, 2025 · control 26-AS-20250826154715

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year inspection visit and met with Tyrone Vega. During visit, LPA toured the facility inside and out. LPA toured the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the first aid kit and found it to be complete. LPA toured 7 out of 7 resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. During visit, facility staff tested the smoke detector system, which functioned properly when tested. LPA tested two out of two carbon monoxide detectors and each one functioned properly when tested. LPA toured four out of four resident bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured from 114 F to 119 F. LPA toured the outside area and found the exits to be clear of obstructions. The emergency disaster drill log indicates the last drill occurred on 08/08/2025.LPA reviewed seven out of seven resident records, including Centrally Stored Medication and Destruction Records, and found them to be complete. LPA reviewed seven staff records and found them to be complete. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Tyrone Vega and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

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

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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 23, 2024 · control 26-AS-20210303162449

Allegation investigated: Facility staff is accepting residents under the age of 60 without an exception.

Licensing Program Analysts (LPA) David Marrufo and Santino Fortes conducted an unannounced complaint investigation visit and met with Rachelle Recinto, Administrator (ADM). On 05/03/2024, the Department received a complaint with the above allegation. On 05/10/2024, LPA Marrufo conducted an initial complaint investigation visit and observed residents and obtained copies of resident records. Review of resident records indicate that residents R1-R11 are admitted residents at the facility. Residents R2, R3, and R6 were under the age of 60 during the visit on 05/10/2024. Residents R1, R4, R5, and R7-11 were aged 60 years old or over during the visit on 05/10/2024. See LIC9099-C for more information. Page 1 of 3. Unfounded Resident R2 has a Primary Diagnosis of Dementia, is not able to transfer from bed, and is non-ambulatory. R3 has a Primary Diagnosis of Down’s Syndrome and a Secondary Diagnosis of Alzheimer’s disease. R6 has a Primary Diagnosis of Degenerative Disease of Nervous System and Kidney Disease and is on hospice. Residents R5, R7, R8, and R11 have a primary diagnosis of Dementia. R1 and R10 are not able to transfer from bed. R1 and R10 are non-ambulatory. R7 has a diagnosis of Down’s Syndrome. R11 has Alzheimer’s disease. R7 is on hospice. LPA Marrufo reviewed the Appraisal/Needs and Services Plans for Residents R1-R11. LPA Marrufo did not observe any different requirements for care and supervision in the Appraisal/Needs and Services Plans in resident R2, R3, and R6 compared to the Appraisal/Needs and Services Plans of the rest of the residents. During visit on 09/24/2024, LPA Marrufo interviewed staff S1-S4 and ADM, who all stated that residents receive the same level of care. ADM stated during interview that ADM does not accept prospective residents under 60 years old if they do not have the same level of care as the residents who are over 60 years old. On 09/24/2024, LPA Marrufo made telephone calls to the Authorized Persons (AP) of residents R1-R11. LPA Marrufo was able to conduct telephone interviews with resident R3’s AP (AP1), resident R6’s AP (AP2), and resident R7’s AP (AP3). AP1 stated that R3 needed a much higher level of care than the other residents. AP1 stated that R3 needs pureed food, cannot eat alone, is not independent with the toilet, and is non-verbal. After reviewing the Physician’s Reports for resident R1-R11, LPA observed that R4 is not able to care for his/her own toilet needs; R7 requires pureed food and needs support with bowel impairment and is able to communicate some words; R9 is not able to feed self; R10 is not able to care for his/her own toileting needs. AP2 stated that R6 is currently on hospice. AP2 stated that when R6 was first admitted to the facility, R6’s level of care was the same as the other residents before R6 was put on hospice. Page 2 of 3. AP3 stated to not know if residents under 60 years old at the facility require a different level of care than those over 60 years old. This agency has investigated the complaint allegations listed. Based on interviews and review of records, the CCLD 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 ADM Rachelle Recinto and a copy of this report was provided. Page 3 of 3. END REPORTthe state’s words, verbatim · CDSS document, Sep 24, 2024 · control 26-AS-20240503141412

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Rachelle Recinto. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed locked storage areas for cleaning supplies and sharp objects. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. The first aid kit was observed and found to be complete. LPA toured the outdoor area and found the exits to be clear of obstructions. LPA toured 7 out of 7 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as working lights. LPA tested the hallway carbon monoxide detector and found it to function properly when tested. The facility has a centrally connected smoke detector system. The smoke detector system was tested and found to function properly when tested. LPA toured two out of two resident hallway bathrooms. Each bathroom had working lights and available soap and paper towels. The showers had grab bars, shower chairs, and anti-slip mats. The water temperatures in the bathroom sinks were measured at 119 F. LPA reviewed 5 resident files and 5 staff files and found them to be complete. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Rachelle Recinto and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 22, 2024