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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202734
Report Date: 03/07/2022
Date Signed: 03/07/2022 11:59:44 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2020 and conducted by Evaluator Marybeth Donovan
COMPLAINT CONTROL NUMBER: 26-AS-20200813135559
FACILITY NAME:SUNRISE VILLA SALINASFACILITY NUMBER:
275202734
ADMINISTRATOR:AMY SAULNIERFACILITY TYPE:
740
ADDRESS:1320 PADRE DRIVETELEPHONE:
(831) 754-5532
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:185CENSUS: 145DATE:
03/07/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Amy SaulnierTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Facility staff are charging resident to use the pharmacy of their choice
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the finding to the above allegation. LPA met with Saulnier Executive Director.

3 staff were interviewed and staff stated the facility changed pharmacy provider in October 2020 and gave the residents a 60-Day notice of change. The residents can use a pharmacy of their choice, however, a $75 per month optional service fee would be charged for medication review and follow up with the pharmacy.

7 residents were interviewed. 7 out of 7 residents do not have any concerns or issues regarding the medication management program.

Notification to residents regarding facility pharmacy selection was reviewed. If the resident does wish to use the preferred pharmacy, the resident will be charged an optional service fee of $75 per month.

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Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
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 2
Control Number 26-AS-20200813135559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SUNRISE VILLA SALINAS
FACILITY NUMBER: 275202734
VISIT DATE: 03/07/2022
NARRATIVE
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Residency Agreement reviewed and stated a 60-Day notice will be given for change of rate for accommodations and services, or charges for optional items or services.

The Department has investigated the above allegation, and based on interviews and record reviews, the Department has determined that the allegation was Unfounded, meaning that the allegation was false, could not have happened and/or are without reasonable basis.

LPA reviewed the report Amy Saulnier Executive Director and a copy provided.


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SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Marybeth DonovanTELEPHONE: (408) 726-4301
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2