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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430702352
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:26:07 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
09/17/2024 and conducted by Evaluator Christine Kabariti
COMPLAINT CONTROL NUMBER: 26-AS-20240917152938
FACILITY NAME:VALLEY PINESFACILITY NUMBER:
430702352
ADMINISTRATOR:HEINAN, JAMESFACILITY TYPE:
740
ADDRESS:545 EAST MAIN AVENUETELEPHONE:
(408) 779-2855
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:49CENSUS: 13DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Carolyn HeinanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff are not trained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegation. LPA met with Licensee, Carolyn Heinan. On 09/17/2024, the Department received the complaint. On 09/24/2024, the initial complaint investigation was conducted. The following documents were obtained to include the resident shower schedules and 3 residents physician’s report and appraisal/needs and services plan. It was alleged that the facility staff are not trained. On 09/24/2024, 2 new staff member’s (S1 & S2) training records were requested. Based on interview and record review, the licensee was unable to produce S1 & S2’s training documentation. The Department has investigated the above allegation. Based on interview, record review and observation the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. A deficiency was cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Carolyn Heinan and a copy of the report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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-20240917152938
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: VALLEY PINES
FACILITY NUMBER: 430702352
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
CCR
87411(c)
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(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement is not met as evidenced by:
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Licensee states to have provided training for S1 and S2. During visit, LPA obtained the training records for S1. Licensee will fax S2's training records to the Department by POC due date.
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Based on interview, record review and observation the licensee did not ensure to provide staff (S1) and (S2) with training which poses/posed a potential health, safety, and personal rights risk to persons in care.
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ILS
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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: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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
09/17/2024 and conducted by Evaluator Christine Kabariti
COMPLAINT CONTROL NUMBER: 26-AS-20240917152938

FACILITY NAME:VALLEY PINESFACILITY NUMBER:
430702352
ADMINISTRATOR:HEINAN, JAMESFACILITY TYPE:
740
ADDRESS:545 EAST MAIN AVENUETELEPHONE:
(408) 779-2855
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:49CENSUS: 13DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Carolyn HeinanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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The Facility is not ensuring residents sheets and bedroom is clean and sanitary at all times.
Facility food is not being served in a safe and healthful manner.
Facility did not ensure that resident's bathing needs are being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegation. LPA met with Licensee, Carolyn Heinan.

On 09/17/2024, the Department received the complaint. On 09/24/2024, the initial complaint investigation was conducted. The following documents were obtained to include the resident shower schedules and 3 residents physician’s report and appraisal/needs and services plan.

It was alleged that the facility is not ensuring the residents sheets and bedroom is kept clean and sanitary at all times. It’s alleged that the resident’s bedsheets are only changed if they have feces or urine on them. It’s alleged that the resident’s bedsheet are changed every 15 days. Page 1 of 3.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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-20240917152938
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: VALLEY PINES
FACILITY NUMBER: 430702352
VISIT DATE: 03/21/2025
NARRATIVE
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3 staff members were interviewed. Based on staff interview, 3 out of 3 staff stated that the residents bedsheets are changed out weekly, unless there is an accident. If there is an accident, then the sheets will be washed immediately upon noticing.

3 residents were interviewed. Based on resident interview, 3 out of 3 residents stated that resident’s laundry is done weekly. 2 out of 3 residents stated that bedsheets are washed weekly, and 1 out of 3 residents stated their bedsheets are washed every 2 weeks. None of the residents had any issues or complaints regarding the laundry schedule.

Based on observation, 3 out of 3 residents bedrooms were observed clean with no foul odor.

It was alleged that the facility food is not served in a safe and healthful manner. It was alleged that the facility serves residents expired food such a bread and fruits and reuses coffee from the day before.

3 staff members were interviewed. Based on interview, 3 out of 3 staff denied reusing coffee from the day before and serving it to the residents. Staff stated that they make fresh coffee every morning for the residents. It was stated that if there is left over coffee from breakfast, they will reheat the coffee for lunch, however, they do not reuse coffee from the day before.

Based on observation of the facility’s food supplies on 09/24/2024, the breads and fruits were observed in good quality and not expired or rotten. LPA observed expired can foods and perishable items inside the pantry and refrigerator. Licensee states the staff and resident’s share the same pantry and refrigerator, which the expired items were the staff’s food and not for the residents.

3 residents were interviewed. 3 out of 3 residents did not have any complaints about the food being served at the facility. 3 out of 3 residents denied being served expired food. It was stated that the fruits being serve are of good quality. Page 2 of 3.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20240917152938
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: VALLEY PINES
FACILITY NUMBER: 430702352
VISIT DATE: 03/21/2025
NARRATIVE
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It was alleged that the facility did not ensure residents bathing needs were met as the licensee does not let the staff use soap during showers. It was alleged that the licensee instructed the staff to only use water.

3 staff were interviewed. Based on staff interview, 3 out of 3 staff stated that the residents are provided showers based on a shower schedule. It was stated that the residents have their own hygiene products to include soap and shampoo, and if needed, the facility also has hygiene products they can use for the residents. Staff denied being told to shower the residents using only water.

3 residents were interviewed. Based on resident interview, 3 out of 3 residents stated that they have their own hygiene products to use for showers. 3 out of 3 residents denied only using water for showers. It was stated the residents have a shower schedule and if they want more shower they just have to ask the staff.

Based on observation, the residents hygiene items are either stored safely in their room (if able) or locked in the shower room where they are assisted by the staff.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded, meaning, the allegations are false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Licensee, Carolyn Heinan and a copy of the report was provided.

Page 3 of 3.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5