440708909-1-26-2026-26-AS-CKAI-DVASL8-20260622135753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 440708909
Report Date: 01/26/2026
Date Signed: 01/26/2026 04:12:17 PM

Substantiated

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
10/14/2025 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20251014102101

FACILITY NAME:	WESLEY HOUSE III		FACILITY NUMBER:	440708909
ADMINISTRATOR:	LEON, JANET		FACILITY TYPE:	740
ADDRESS:	123 LA SELVA DRIVE		TELEPHONE:	(831) 685-0646
CITY:	LA SELVA BEACH	STATE: CA	ZIP CODE:	95076
CAPACITY:	6	CENSUS: 6	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Janet Leon		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff did not provide adequate care and supervision to the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Janet Leon, Administrator. On 10/14/2025, the department received a complaint with the above allegation. On 10/23/2025, LPA Marrufo conducted an initial complaint investigation visit.

When the department received the complaint, witness W1 alleged to have visited the facility on 10/09/2025 to visit resident R1. W1 reported that W1 observed R1 to begin to stand up and show signs of confusion. W1 then called out for a staff to help, but received no response. W1 stated R1 began to walk away from W1 and R1 tripped, but W1 was able to stabilize R1 and present R1 with his/her walker. R1 then began to walk to the restroom. W1 then began to continue to call out to staff for assistance while walking throughout the house but received no response.

See LIC9099-C page for more information. Page 1 of 3.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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 4

Control Number 26-AS-20251014102101

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: WESLEY HOUSE III	FACILITY NUMBER: 440708909
	VISIT DATE: 01/26/2026

NARRATIVE

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W1 observed two other residents by themselves. W1 then went to Wesley House II, which is next door to the facility and owned by the same licensee, and called for help. W1 states a staff then ran to the facility and assisted R1 in the restroom.

During visit on 10/23/2025, LPA Marrufo obtained a copy of R1’s Physician’s Report. R1’s Physician’s Report states R1 requires standby assistance while toileting and R1 can ambulate with assistance.

On 11/14/2025, LPA Marrufo conducted a telephone interview with staff S1. S1 stated that around either November or December of 2025, S1 was working a shift at Wesley House II. S1 stated S2 was working a shift at Wesley House III at the same time. S1 stated that at around 2:00 PM, S2 left Wesley House III to go to the bank without notifying S1 that S2 was leaving the facility. S1 stated to have gone to Wesley House III to check if S2 needed help but did not find S2. S1 observed S2 returning to Wesley House III. Then, S1 returned to Wesley House II.

S1 also stated that there was another occasion when S2 left Wesley House III to pick up medications and S1 provided supervision to both Wesley House II and Wesley House III alone at the same time for about an hour.

On 01/26/2026, LPA Marrufo conducted a telephone interview with S3. S3 stated that there have been times when S3 has been the only staff on duty for both Wesley House II and Wesley House III. S3 stated that the last time S3 had to provide supervision to both facilities alone was around two to three years ago.

On 01/26/2026, LPA Marrufo conducted an interview with witness W2. W2 stated to have observed times when there are no staff present at Wesley House III. W2 stated the staff working in Wesley House III will leave the facility unsupervised to help the staff in Wesley House II move a resident who requires two staff.

Page 2 of 3.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20251014102101

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: WESLEY HOUSE III	FACILITY NUMBER: 440708909
	VISIT DATE: 01/26/2026

NARRATIVE

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**This report was amended on 02/18/2026 to add "An immediate civil penalty of $500 is being assessed for absence of supervision."**
W2 stated to have been present at the facility and to have not observed any sounds of any facility staff at the facility. W2 stated to have later seen S2 in the facility. W2 stated that S2 told W2 that S2 had gone to the pharmacy to pick up medications for S2. W2 stated that he/she told S1 that S2 told W2 that S2 had left the facility to pick up medications for S2.

Based on records review and interviews, there is preponderance of evidence to prove the alleged violation did occur. Therefore, the allegation is substantiated.

See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

An immediate civil penalty of $500 is being assessed for absence of supervision.

This report was reviewed with Hilda Ortiz and a copy of this report and appeal rights were provided.

Page 3 of 3.

END REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20251014102101

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: WESLEY HOUSE III	FACILITY NUMBER: 440708909
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/27/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to submit a plan of correction by 01/27/2026 stating how the licensee will ensure that there is a sufficient number of staff at the facility at all times, including when residents from the neighboring facility, Wesley House II, need two staff to assist them with care.
	8 9 10 11 12 13 14	Amended on 02/18/2026 to issue immediate civil penalty of $500 Based on interviews with two witnesses and two staff, there have been times when there were no staff present in the facility to provide the services necessary to meet resident needs, which poses an immediate safety risk to residents in care. An immediate civil penalty of $500 is being assessed for lack of supervision	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4