Wrc-2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Mark Vasquez and Residential Services Manager (RSM) Elvira Rodriguez. LPA stated the purpose of the visit. During visit, LPA toured the inside and outside of the facility with RSM. All exits and passageways were free and clear of obstruction. LPA toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps, medications and cleaning supplies were locked in secured areas. LPA toured 4 resident bedrooms. 4 Out of 4 resident bedrooms had available bedding, drawers, and functioning lights. The 2 facility bathrooms had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom was measured with a range from 107.4 F to 107.9 F. Fire extinguisher was observed and inspected on 3/18/2026. Facility smoke detectors and carbon monoxide detectors functioned properly when tested by RSM. The last disaster drill was conducted on 5/29/2026. LPA reviewed 2 resident records, and 2 residents centrally stored logs. LPA reviewed 2 staff records. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Residential Services Manager (RSM) Elvira Rodriguez and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 17, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Designated Administrator Elvira Rodriguez. Administrator (ADM) Mark Vasquez was in a meeting during inspection. LPA stated the purpose of the visit. Designated Administrator states the facility has 6 residents. LPA toured the interior and exterior of the facility with Designated Administrator to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. 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 refrigerator temperature log for 6/26/2025 with refrigerator temperature documented at 35 degrees F and freezer at 0 degrees F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by maintenance. Fire extinguishers were last serviced on 5/12/2025. The facility emergency drill log was reviewed. The facility's last drill was on 6/12/2025. Drills are being conducted monthly. Page 1 of 2 LPA toured 4 resident bedrooms. All 4 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 2 bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. At 1:13PM LPA measured water temperature in 2 resident bathrooms with a range from 149.7 degrees F to 150.6 degrees F. Designated Administrator had maintenance staff come to adjust water temperature. At 2:00PM LPA measured water temperature at 150 degrees F. LPA issued a Technical Assistance. LPA reviewed 4 resident records. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA observed Resident R1 and R2 were not given the correct medication dosage on 6/24/2025. Designated Administrator stated R1 and R2 physicians were informed and no adverse reactions were observed for R1 and R2. LPAs reviewed 4 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. A Technical Assistance was issued. See LIC9102 for more information. An exit interview was conducted with Designated Administrator Elvira Rodriguez and a signed copy of this report was provided. Page 2 of 2the state’s words, verbatim · CDSS document, Jun 26, 2025

Allegation investigated: Staff will not allow resident to return to the facility.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Staff, Claudia Nieto and stated the purpose of today’s visit. Administrator was not available during today's visit. On 1/26/2024, the Department received a complaint with the above allegations. On 1/26/2024, the Department conducted an initial investigation at the facility. It was alleged the facility staff stated resident (R1) cannot return to the facility from the hospital because the resident needs a higher level of care. On 1/16/2024, R1 went to the hospital and was assessed at the hospital. The hospital staff determined R1 was not appropriate for hospital admission and notified facility Administrator (ADM) Megan Miller. ADM stated R1 could not return to the facility due to R1 requiring higher level of care. Continuation on LIC 9099-C, Page 1 of 2. Unfounded Page 2 of 2. On 1/26/2024, LPA Rai interviewed ADM and Staff S1. ADM stated R1 was taken to the hospital via ambulance due to R1 not able to ambulate to the bed in the evening. ADM stated she was working with the hospital to assess if the resident was diagnosed with Dementia. ADM stated the facility staff were looking for skilled nursing placement before resident went to the hospital due to a decline in R1’s health and increased confusion. ADM stated R1 was brought back to the facility, and they are working to obtain a referral with the neurologist for a consultation. ADM notified the hospital social worker stating R1’s bed is open and R1 was not being evicted at this time, but the resident needed higher level of care such as skilled nursing as order my R1’s physician. Based on record review, R1 had an appointment on 1/12/2024 with Physician’s Assistant who recommended facility to pursue skilled nursing facility placement since the reason for the appointment was “confusion, falling and wandering”. Based on review of R1’s hospital discharge notes on 1/16/2024, R1 was diagnosed with neurocognitive disorder without behavioral disturbance. During visit 1/16/2024, R1 was admitted back to the facility and ADM stated they are working with R1’s primary care physician to find a facility to be able to care for residents with Dementia. ADM stated facility had not issued a formal eviction notice. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Staff, Claudia Nieto and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 21, 2024 · control 26-AS-20240126131739

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Administrator (ADM) Megan Miller. LPA Rai observed 1 staff (S1) and 4 residents at the facility. During the visit, 1 residents was out of the facility. The residents at this facility are overseen by Santa Cruz County Behavioral Health. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the resident bedrooms. 4 Out of 4 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 109.7 degrees F - 110.7 degrees F. The water temperature in the kitchen sink was 111.7 degrees F. Fire extinguisher was observed and inspected on 5/30/2024. Facility smoke detectors and carbon monoxide detectors are in working condition. The last two disaster drill conducted were on 4/18/2024 and 5/20/2024. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. LPA Rai reviewed resident's LIC 405 Record of Resident's Safeguarded Cash Resources. No issues or concerns were observed. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator (ADM) Megan Miller and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 28, 2024