Rachelle's Home III

Allegation investigated: Staff physically abused resident by forcing resident to shower

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint visit to deliver the findings of the above allegation. LPA met with Administrator (ADM) Myla Ilagan. LPA stated the purpose of the visit. On 3/18/2026 the Department received a complaint with the above allegation. On 3/19/2026 the Department interviewed the Reporting Party (RP). RP states a resident, referred to as R1, was ‘accosted’ by two staff members on 3/5/2026 by Staff S1 and Staff S2. RP states R1 was going to his/her room to change due to having a ‘bladder problem.’ RP states S1 and S2 grabbed R1 and ‘dragged’ R1 into the shower. Page 1 of 3 Unsubstantiated On 3/25/2026 the Department conducted a complaint visit and interviewed the Licensee Rachelle Recinto, 3 Staff (S1 to S3) and 1 Resident (R1). Licensee stated there was an incident on 3/5/2026 with R1, when R1 was observed to be soiled in the dining area. Licensee stated R1 was offered help with a shower, to which R1 agreed to let staff help him/her with a shower. Licensee stated R1 walked with S1 and S2 to the shower. Licensee stated she then heard screaming and went to check on R1. Licensee stated she stood at the bathroom shower doorway and saw that R1 was being showered. Licensee stated S2 told her that R1 did not want to shower anymore. Licensee stated she could not leave R1 in the shower, due to safety concerns of the floor being wet and R1 is a fall risk. Licensee stated S1 and S2 helped R1 out of the shower and S1 and S2 were told to leave R1 alone. Licensee stated that she and the facility staff “try so hard to help” R1 with bathing, toileting and dressing as part of R1’s care plan. Licensee stated R1 does not allow staff to help him/her with bathing, toileting and dressing. Licensee stated staff are scared of R1 because R1 will scream, yell, and make offensive statements to staff. Licensee stated R1 walks around the facility with soiled briefs/clothing and refuses to change. Licensee stated this is an ongoing hygiene concern and R1’s care team is aware of R1’s hygiene and refusal of care since 2025. On 3/25/2026 the Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff state he/she is not aware of any incident where staff physically abused a resident by forcing the resident to shower. S1 stated on 3/5/2026 he/she was asked by the Licensee to help R1 to shower because R1 was soiled. S1 stated R1 agreed to let staff him/her. S1 stated S2 also helped R1 during this incident. S2 stated he/she was asked by Licensee to help R1 with a shower. S2 stated R1 agreed to let staff help him/her with a shower. S2 stated S1 helped bathe R1. S2 stated R1 then said he/she did not want to shower anymore. S2 stated R1 let S1 help him/her to get out of the shower and to put his/her clothes on. On 3/25/2026 the Department interviewed Resident R1. R1 stated on 3/5/2026, he/she was dragged into the shower by two staff, S1 and S2. R1 stated he/she did not agree to staff helping him/her with a shower. R1 stated he/she did not ask for staff to help him/her. R1 stated he/she does not need help with bathing/showering. Page 2 of 3 On 4/1/2026 the Department interviewed Witness 1 (W1). W1 stated he/she is aware of R1’s refusal of care by facility staff since 2025. W1 stated R1’s hygiene is an ongoing concern. W1 stated R1 is known to have behaviors of saying staff force him/her to bathe/shower when R1 is soiled. W1 stated R1 refuses medical and psychiatric care, calling doctors and psychiatrists ‘liars.’ W1 stated R1 is not receptive to care due to R1 having mental health impairments. Review of R1’s physician’s report dated 1/27/2026, R1 diagnoses are mild cognitive impairment, with development of major neurocognitive impairment. R1’s physical health status is listed as having bladder incontinence, difficulty with balance and requiring assistance with repositioning and transferring. R1’s capacity for self care is listed as able to bathe, dress/groom, and care for own toileting needs. Review of R1’s Needs and Services plan dated 2/16/2026, R1’s mental status notes R1 refusal to shower, aggressive toward staff, with staff offering to help with personal hygiene. R1’s Physical Health, R1 refuses showers and help with changing, staff are to offer help daily to shower and remind to change briefs/diapers. Review of Santa Cruz County Sheriff’s Office Daily Press Log from 3/1/2026 to 3/15/2026 notes an incident on 3/5/2026 at approximately 3:00PM. Review of the sheriff’s report noted R1 was interviewed and it was determined that no crime had been committed, and no injuries were observed. No additional follow up was conducted by the sheriff’s department. 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. No deficiencies were cited during today’s visit, per California Code of Regulations, Title 22. An exit interview was conducted with Administrator (ADM) Myla Ilagan and a copy of this report was provided. Page 3 of 3 END OF REPORTthe state’s words, verbatim · CDSS document, Apr 13, 2026 · control 26-AS-20260318100030

Allegation investigated: Staff did not prevent residents from eloping from the facility

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. Page 1 of 2 Unsubstantiated 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.the state’s words, verbatim · CDSS document, Feb 25, 2026 · control 26-AS-20260204090906

Type of visit: Required - 1 Year

On 1/21/2026 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Myla Ilagan. LPA explained the purpose of the visit. LPA toured the facility inside and outside including random resident rooms and kitchen area. LPA observed residents resting in their bedrooms and other residents watching TV in the living room. While touring the facility it was observed that the room temperature was at 70 deg F. Hot water was also tested in the bathrooms and the temperature was 108 deg F. All bathrooms have bath mats. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Food supply in kitchen was observed with an adequate two day perishable and seven day non-perishable. Carbon monoxide/ smoke detectors, sprinklers, and fire extinguisher were present throughout the facility. Emergency drills are done every quarter. Five resident records and five staff records were reviewed. Staff have criminal record and fingerprint clearances on file. Staff have current First Aid/CPR certifications on file. Resident records were reviewed and were observed to be complete. Centrally stored medication was locked in 2 medicine carts and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. No deficiencies being cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management-Other and met with Administrator Myla Ilagan. The purpose of this visit is to follow up on deficiencies that were issued during an Annual Inspection on 1/16/2025. LPA explained the purpose of the visit to ADM. LPA observed 18 clients and 6 staff at the facility. On 1/16/2025, LPA conducted an Annual Inspection visit. During review of resident records, LPA observed that R3 and R8's medical assessment's ambulatory status is non-ambulatory. R3 and R8 occupy ambulatory rooms. A deficiency was issued and a Plan of Correction (POC) was developed with the ADM. The ADM stated the facility would talk with the families of R3 and R8 about moving into the appropriate rooms based on their ambulatory status. LPA also issued a deficiency for 19 resident bathrooms that did not have slip-resistant mats. ADM stated the facility would purchase slip-resistant mats for 19 resident bathrooms as part of the POC. During today's visit, LPA inspected R3 and R8's room and observed R3 and R8 are still in ambulatory rooms. ADM stated she was still working with the families of R3 and R8 about moving rooms. LPA advised ADM to submit a fire clearance request to the Department by the end of visit today 3/12/2025. ADM submitted fire request to Department during visit. LPA inspected 19 resident bathrooms and observed a non-skid mat in each resident bathroom. LPA cleared the deficiencies cited on 1/16/2025 during today's visit. A Letter of Deficiency Citations Cleared was printed and provided to ADM during today's visit. No deficiencies were cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with ADM Myla Ilagan and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Myla Ilagan. LPA toured the interior and exterior of the facility with ADM to include the kitchen, office, resident rooms, dining room, bathrooms, back and front of the facility. The facility is a residential care home for the elderly, and consists of two large buildings, Wing A and Wing B. Facility thermostat temperature display was observed at 68 degrees F. All exit and passageways were free and clear of obstruction. At 9:50 AM LPA toured the Wing B of the facility. LPA observed the facility thermostat temperature display at 68 degrees F. LPA toured 8 resident rooms in Wing B. LPA observed 7 out of 8 resident rooms to have functioning lights, a bed, a dresser/table and storage space for personal belongings. LPA observed 7 out of 8 resident bathrooms had functioning lights, paper towels and hand soap. 7 out of 8 resident bathrooms had no slip-resistant mats on the bathroom floor. At 9:55AM, during tour of resident rooms, LPA observed a male staff member asleep in an unoccupied bedroom (#18). ADM stated the staff member would be leaving and had worked the overnight shift. LPA advised ADM that facility shall be large enough to provide comfortable living accommodations and privacy to staff members who may reside in the facility. At 10:15AM LPA toured the Wing A of the facility. LPA toured 13 resident rooms in Wing A. 13 out of 13 resident rooms had functioning lights, a bed, a dresser/table and storage space for personal belongings. 7 out of 7 resident bathrooms have paper towels, hand soap and functioning lights. LPA measured hot water temperature with a range from 105 to 112.2 degree F in resident bathrooms. See LIC809C At 10:30AM, LPA toured resident room #1 and bathroom #1 (unoccupied), and observed the room was converted to storage space. LPA advised ADM to submit an updated facility sketch to include the converted bedroom #1 and bathroom #1 to storage space. LPA also observed 6 out of 7 resident bathrooms did not have slip-resistant mats on the floor. At 10:45AM LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 10/31/2024. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 11/24/24. LPA reviewed 8 resident records. 8 out of 8 resident records were found to be complete. Resident records included emergency contact information, physician’s report, appraisal/needs and service plans, and personal rights. During resident record review, LPA observed that R3 and R8's medical assessment's ambulatory status is non-ambulatory. R3 and R8 occupy ambulatory rooms. LPA advised ADM to partner with the families of R3 and R8 to move residents to non-ambulatory rooms. LPA reviewed 8 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). 8 out of 8 CSMDR’s were observed to be complete with all medication documented. LPAs reviewed 7 staff records. 7 out of 7 staff records were found to be complete. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record and staff training. LPA observed that 5 staff were not associated to the facility, but had obtained fingerprint background clearance. LPA advised ADM to associate staff to the facility by 1/17/2025. Deficiencies were cited during today’s visit per California Code of Regulations Title 22. See LIC809-D. A Technical Violation was also issued. See LIC9102 for more information. An exit interview was conducted with ADM Myla Ilagan. A signed copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

Allegation investigated: Facility is in disrepair

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator Myla Ilagan. On 02/20/2024, the Department received a complaint with the above allegation. The Department received two photographs from a witness showing a leak near a pipe on the outside area of the facility. During visit, LPA Marrufo observed two pipes, one black pipe along the wall on the exterior of the kitchen and another protruding from the ground. There was a puddle of water near the pipe on the ground that was about a foot long and 5 inches wide. LPA Marrufo observed a sandbag along the wall of an adjacent facility building and another two sandbags near the door of the same adjacent facility building. See LIC9099-C for more information. Page 1 of 3. Unsubstantiated During visit, LPA Marrufo obtained a copy of an invoice from a plumbing company. The invoice is dated 12/27/2023. The Invoice states it is for labor and the installation of a pipe. The Invoice describes the work as “*ran snake cleaned kitchen drain, ran snake cleared tub pulled out hairs, raised up kitchen vent and put in line vent@ 4101 fairway dr.” During interview, Administrator Myla Ilagan stated that water from the kitchen sink sometime overflows and pours from the pipe along the exterior wall. Then, the water will pour onto the ground. Administrator stated that she recalls that the plumbing company installed the black pipe along the exterior of the kitchen wall. Administrator stated to have notified the plumbing contractor afterwards via telephone that the pipe is still leaking, and the plumbing contractor visited the facility again briefly and stated that they needed to order more parts to fix the leak. Administrator stated the plumbing company did not leave any documentation of the last visit. LPA Marrufo conducted a telephone interview with Plumbing Company Staff PC1, who stated that the plumbing company installed the longer black pipe on the exterior kitchen wall on 12/27/2023. PC1 stated to not have any documentation on a shorter pipe that the company had previously installed. PC1 stated to not have any documentation of a visit in which a plumbing contractor visited the facility and stated to need to order additional parts. During visit, LPA Marrufo interviewed staff S1, who is a maintenance staff at the facility. S1 stated to have observed the leak occurring outside of the facility. S1 stated that the leak has been reoccurring. S1 stated that a plumbing company came to fix the leak “about a month ago.” Page 2 of 3. During visit, LPA Marrufo interviewed staff S2, who stated that the leaks have only occurred from the pipe along the exterior of the kitchen wall and not from the pipe from the ground outside of the facility. S2 stated that a plumbing contractor came to the facility and installed a short pipe along the kitchen exterior wall, but the short pipe still leaked when the kitchen sink overflowed. S2 stated the plumbing contractor visited again and installed the longer black pipe that is currently installed along the exterior of the kitchen wall. S2 stated the plumbing contractor instructed staff to remove the cap on the top of the black pipe to allow air to flow and push water down if the pipe is overflowing. Based on information from interviews conducted with staff, and records reviewed, and observations made, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22 LPA Marrufo requests an Action Plan by the facility which discusses how the facility plans to ensure that the leak outside of the facility kitchen will be fixed and how the facility will ensure the residents remain safe from the leak while repairs are ongoing. LPA Marrufo requests that the Action Plan be submitted within 7 days. This report was reviewed with Myla Ilagan and a copy of this report was provided. Page 3 of 3. END REPORTthe state’s words, verbatim · CDSS document, Feb 29, 2024 · control 26-AS-20240220080053

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Steve Chang and Mita Partoza conducted an unannounced pre licensing inspection, and met with administrator (ADM) Myla Ilagan. LPAs observed 17 residents and 7 staff at facility. LPAs toured the facility with ADM inside and out. LPA inspected living room, dinning rooms, kitchen. There are 3 common restrooms, staff live-in room, 19 resident rooms in facility. Some bathrooms were observed without non skid pads. ADM stated the facility will put the non skid pad in the bathrooms. Two days perishable foods and seven days non perishable foods were observed sufficient. Room temperature was observed at 71 degree F, hot water temperature was observed at 109 degree F. Temperature of refrigerator was measured at 40 degree F, and temperature of freezer was observed at 0 degree F. Medication cabinet, and cleaning products closet were observed locked. Knives cabinet was observed unlocked. ADM stated the facility will fix this issue. 3 window screens were observed not in good repair. ADM stated the facility will fix this issue.s Fire extinguisher was serviced on 7/5/2023. The facility is equipped with fire alarm and carbon monoxide detectors. Smoke detector alarm system were tested, and were working fine. First Aide Box was observed in the facility. Night lights was not observed in the hallway. ADM stated the facility will put the night light at the hallway. Front yard and backyard were inspected. There was no obstruction to block the walkways.Facility last fire and emergency drill was conducted on 12/08/2023. Component III was conducted with ADM. No citation was issued today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.the state’s words, verbatim · CDSS document, Dec 13, 2023