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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 440703228
Report Date: 04/09/2026
Date Signed: 04/09/2026 03:47:41 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
02/19/2026 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20260219165639
FACILITY NAME:HANOVER GUEST HOMEFACILITY NUMBER:
440703228
ADMINISTRATOR:MARSHA BELLEZAFACILITY TYPE:
740
ADDRESS:813 HANOVER STREETTELEPHONE:
(831) 426-0618
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:15CENSUS: 11DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Marsha BellezaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff does not ensure transportation arrangements are made for resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit to deliver case findings. LPA met with Administrator Marsha Belleza. LPA stated the purpose of the visit.

On 2/19/2026 the Department received a complaint with the above allegations.

On 2/25/2026 the Department conducted the initial complaint investigation visit and interviewed the Administrator (ADM) Marsha Belleza and 1 Staff (S1). ADM states she does not personally drive residents to their medical or dental appointments but arranges for transportation to resident’s appointments through an outside agency. ADM states she has also informed families about outside agencies that provide transportation for appointments.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 26-AS-20260219165639
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: 04/09/2026
NARRATIVE
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On 2/25/2026 the Department interviewed 1 Staff (S1). S1 states both she/he and ADM will make arrangements to take residents to medical or dental appointments. S1 states she is not aware of any residents not being taken to his/her appointments. S1 states she or ADM have not refused to take or arrange to take residents to his/her appointments.

On 4/7/2026 the Department interviewed 3 Witnesses (W1 to W3). 3 Out of 3 Witnesses states he/she has no concerns with the care his/her loved one is receiving at the facility.

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 per California Code of Regulations Title 22. An exit interview was conducted Administrator (ADM) Marsha Belleza and a copy of this report was provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
02/19/2026 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20260219165639

FACILITY NAME:HANOVER GUEST HOMEFACILITY NUMBER:
440703228
ADMINISTRATOR:MARSHA BELLEZAFACILITY TYPE:
740
ADDRESS:813 HANOVER STREETTELEPHONE:
(831) 426-0618
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:15CENSUS: 10DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Marsha BellezaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff does not ensure resident has an updated needs and services plan
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit to deliver case findings. LPA met with Administrator Marsha Belleza. LPA stated the purpose of the visit.

On 2/19/2026 the Department received a complaint about the above allegations.

On 2/25/2026 the Department conducted the initial complaint investigation visit and interviewed the Administrator (ADM) Marsha Belleza and 1 Staff (S1). ADM states if a resident does not have an updated care plan it’s because she ‘just didn’t do it.’

On 2/25/2026 the Department interviewed 1 Staff (S1). S1 states he/she does not complete care plans for residents. S1 states the ADM completes resident care plans.

Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 26-AS-20260219165639
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: 04/09/2026
NARRATIVE
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On 2/25/2026 the Department reviewed 3 resident files. 2 Out of 3 resident files did not contain updated needs and services plans. R2 and R3 have neurocognitive impairment.

On 4/7/2026 the Department interviewed 3 Witnesses (W1 to W3). 3 Out of 3 Witnesses states he/she has no concerns with the care his/her loved one is receiving at the facility.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be substantiated. California Code of Regulations Title 22 are being cited on the attached LIC 9099 D. An exit interview was conducted with Administrator Marsha Belleza, and a copy of this report was provided.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20260219165639
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2026
Section Cited
CCR
87705(c)(5)
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87705 Care of Persons with Dementia (c)(5) Each resident with dementia shall have an annual medical assessment ... and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.
This requirement was not met as evidenced by;
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Administrator states she will submit a plan of action on how she will ensure resident care plans are updated annually. Administrator will submit POC by POC due date of 4/16/2026 to CCL via email.
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Based on record review and interview, both R2 and R3's needs and services plans have not been updated annually. Both R2 and R3 have neurocognitive impairment. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5