440703228-1-23-2026-26-AS-CKAI-DQSQU6-20260129112812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 440703228
Report Date: 01/23/2026
Date Signed: 01/23/2026 01:10:32 PM

Unfounded

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
01/21/2026 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20260121091934

FACILITY NAME:	HANOVER GUEST HOME		FACILITY NUMBER:	440703228
ADMINISTRATOR:	MARSHA BELLEZA		FACILITY TYPE:	740
ADDRESS:	813 HANOVER STREET		TELEPHONE:	(831) 426-0618
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	15	CENSUS: 11	DATE:	01/23/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Designated Administrator Wendy Sanchez		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not notify resident's responsible party of an incident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit and met with Designated Administrator Wendy Sanchez. LPA stated the purpose of the visit. Designated ADM called Administrator (ADM) Marsha Belleza to inform her of LPA Tarin at the facility. LPA Tarin spoke with ADM. ADM stated she was not well and would not be able to be present for the complaint visit.

On 1/21/2026 the Department received a complaint with the above allegation.

On 1/21/2026 the Department interviewed Witness 1 (W1). W1 states the facility staff did not notify him/her when resident, referred to as R1, fell on 1/17/2026.

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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-20260121091934

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: HANOVER GUEST HOME	FACILITY NUMBER: 440703228
	VISIT DATE: 01/23/2026

NARRATIVE

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On 1/23/2026 the Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff state the facility notifies families when his/her loved one has had a fall. S2 states he/she notified R1's responsible party on 1/21/2026 regarding R1 having fallen, and the facility was going to call 911. S2 states she is not aware of R1 having a fall on 1/17/2026.

Based upon review of phone call logs made to R1's responsible party on 1/20/2026, 1/21/2026,1/22/2026, the responsible party's phone number was incorrectly listed in the saved contact information.

LPA also observed the resident's emergency contact sheet on the kitchen refrigerator to incorrectly list R1's responsible party's phone number.

Facility staff updated R1's responsible party's phone number to the correct phone number during visit today.
This agency has investigated the complaint alleging staff did not notify resident's responsible party of an incident. We have found that the complaint was UNFOUNDED meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Staff Silvia Pintor De Sanchez. Designated Administrator Wendy Sanchez had an appointment and was not present during the exit interview. A copy of this report was provided. No deficiencies were cited during today's visit per California Code of Regulations, Title 22.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

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