430702352-4-11-2025-26-AS-KHOS-DGLR7V-20250512124659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430702352
Report Date: 04/11/2025
Date Signed: 04/11/2025 04:25:10 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
09/12/2024 and conducted by Evaluator Christine Kabariti

COMPLAINT CONTROL NUMBER: 26-AS-20240912155005

FACILITY NAME:	VALLEY PINES		FACILITY NUMBER:	430702352
ADMINISTRATOR:	HEINAN, JAMES		FACILITY TYPE:	740
ADDRESS:	545 EAST MAIN AVENUE		TELEPHONE:	(408) 779-2855
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	49	CENSUS: 13	DATE:	04/11/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Carolyn and James Heinan		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff neglected resident by leaving resident in soiled diaper all day resulting in a pressure injury
Facility has insufficient number of staff to meet the residents needs
Facility staff did not report a resident's change of condition to the resident's responsible party

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding regarding the above allegation. LPA met with Licensees James and Carolyn Heinan.

On 09/12/2024, the Department received a complaint regarding the above allegations. On 09/16/2024, the initial complaint investigation was conducted. The following documents were obtained to include the resident roster, physician reports, appraisal/needs and services plans, pre-placement appraisals, identification and emergency contact information, centrally stored medication record, incident reports, staff timecards, and police report. Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

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-20240912155005

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: 04/11/2025

NARRATIVE

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It was alleged that the facility staff neglect resident by not providing services to include change the resident diapers leaving resident (R1) in soiled diaper all day resulting in a pressure injury.

The review of records show that R1 does have history of skin breakdown to include skin breakdown in the sacral.

Staff members were interviewed. Based on staff interview, it was stated that the facility had a former caregiver who left the facility on 08/31/2024, who provided all care to R1. Since that caregiver left, the facility staff was having difficulties in providing R1 care.

Staff stated that the caregivers do try to assist R1 with changing his/her soiled diapers, however, R1 refuses to be changed most of the time. Staff stated that they cannot force R1 if he/she refuses but will be give the resident space and try again later. Staff stated that they observe the residents very frequently and assist with incontinent care, if needed. It was stated that if a resident's is observed soiled, they would assist the resident right away in changing the resident's diaper. Staff denied leaving any residents soiled.

Resident (R1) was interviewed. Based on resident interview, R1 denied being left in soiled diapers for a long time.

It was alleged that the facility does not have sufficient number of staff to meet the residents needs. It was alleged that on 09/08/2024, there was only 1 staff at the facility.

Staff members were interviewed. Based on staff interview, it was stated that majority of the residents at the facility, besides R1, are are able to take care of their activities of daily living with minimal staff assistance. Staff states that they are able to take care of all the residents’ needs within their shift.

The Licensee denied a staffing shortage. It was stated that they have at least 1-2 caregivers for the whole building per shift, as all their residents, besides R1, does not require additional care where they need more caregivers. Page 2 of 3.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 26-AS-20240912155005

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: 04/11/2025

NARRATIVE

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3 residents were interviewed. 1 out of 3 residents stated that the facility does not have enough staff. This resident stated that he/she always needs help getting in and out of bed, but because of the staffing sometime they come a little late if the staff are too busy.

2 out of 3 residents did not have any issues or concerns regarding the staffing levels at the facility. These residents stated that they get help from staff when needed.

Based on review of the facility’s compliance history, there are no serious incidents reported that resulted from insufficient staffing numbers.

It was alleged that the facility did not report R1’s change of condition of a toe infection to the resident’s responsible party.

Based on record review, it was found that R1’s alleged toe infection was observed and reported by a vendor who provided manicures and pedicures for the residents. The vendor did not state that R1’s toe was infected but stated to have observed discoloration and advised R1’s family to seek medical advice.

Based on interview with the Licensees, they denied the knowledge of R1’s toe being infected. 2 caregivers who were interview, denied the knowledge and observation of R1’s alleged toe infection. 2 staff denied being informed that R1 even had a toe infection.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unsubstantiated. An unsubstantiated finding indicates that although the allegations may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensees, James and 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: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

LIC9099 (FAS) - (06/04)

Page: 3 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
09/12/2024 and conducted by Evaluator Christine Kabariti

COMPLAINT CONTROL NUMBER: 26-AS-20240912155005

FACILITY NAME:	VALLEY PINES		FACILITY NUMBER:	430702352
ADMINISTRATOR:	HEINAN, JAMES		FACILITY TYPE:	740
ADDRESS:	545 EAST MAIN AVENUE		TELEPHONE:	(408) 779-2855
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	49	CENSUS:	DATE:	04/11/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Carolyn and James Heinan		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff is not treating resident with dignity by belittling and yelling the residents
Facility staff violated the resident's personal rights by forcing them to stay in the room and leave the bedroom door open
Facility staff did not provide resident with reasonable accommodation to the resident's request

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20240912155005

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: 04/11/2025

NARRATIVE

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It was alleged that facility staff are not treating residents with dignity by belittling and yelling at the residents. 3 residents were interviewed. 3 out of 3 residents denied staff not treating the residents with dignity by belittling and yelling at the residents. 3 witnesses were interviewed. 3 out of 3 witnesses denied the observation of facility staff not treating the residents with dignity by belittling and yelling at the residents. 7 staff members were interviewed. 7 out of 7 staff members denied facility staff not treating residents with dignity by belittling and yelling at the residents.

It was alleged that the facility staff violated the resident’s personal rights by forcing them to stay in the room and leave the bedroom door open. 3 residents were interviewed. 3 out of 3 residents denied being forced to leave their bedroom door open. Residents states they voluntarily leave their bedroom door open sometimes. 3 witnesses were interviewed. 3 out of 3 witnesses denied the observation of resident’s being forced to leave their bedroom door open. 7 staff members were interviewed. 7 out of 7 staff members denied forcing the residents to leave their bedroom door open. It was stated that the residents are able to leave their doors open or closed and the facility does not have any rules about that.

It was alleged that the facility did not provide R1 with reasonable accommodation to R1’s request of only female caregivers to provide care to R1. Resident (R1) was interviewed. Based on resident interview, R1 prefers women caregivers. R1 denied male caregivers providing care to him/her. R1 states there is a male staff who only assists him/her out of bed but R1 consents to it.

The Department has investigated the above allegations. Based on interviews, 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 Licensees, James and Carolyn Heinan and a copy of the report was provided. Page 2 of 2.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5