<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430702352
Report Date: 06/20/2025
Date Signed: 06/20/2025 01:52:06 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
03/06/2025 and conducted by Evaluator Christine Kabariti
COMPLAINT CONTROL NUMBER: 26-AS-20250306164216
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:
06/20/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:James & Carolyn HeinanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility left resident in soiled diapers for an extended period of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegations. LPA met with Licensees James and Carolyn Heinan.

On 03/06/2025, the Department received the complaint. On 03/13/2025, the initial complaint investigation was conducted. The following documents were received to include staff timecards, and resident (R1)'s physician's report, preplacement appraisal, appraisal/needs and services plan, identification and emergency contact information, and functional capabilities.

It was alleged that the facility left resident in soiled diapers for an extended period of time on 02/28/2025 as R1 was found completely soiled with urine and feces by R1’s private caregiver around 7:00am. Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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-20250306164216
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: 06/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
7 residents were interviewed. 6 out of 7 residents are independent and are able to care for their own activities of daily living which they denied being left soiled for an extended period of time.

1 out of the 7 residents (R1) states he/she wakes up soiled every morning. R1 stated that there is someone who comes to assist in him/her with changing every morning.

Based on interview with the licensee, it was stated that R1 has a private caregiving agency that comes to assist R1 during morning and nighttime care. R1’s private caregivers assist’s R1 with changing, incontinent care, bathing, grooming, and transferring in and out of bed.

It was stated that if R1 soiled him/herself through the night, R1 will be changed in the morning when R1’s private caregiver starts around 7:00am.

The licensee stated that the facility has an awake night staff, however, the staff does not assist with incontinent care throughout the night because they are unable to lift R1. It was stated that R1’s responsible parties were made aware of this which is the reason they hired a private caregiver from an agency. It was stated that R1 does not have a private caregiver from the hours of 8:00pm – 7:00am.

The Department has investigated the above allegation. Based on interview and record review 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. See LIC9099-D.

This report was reviewed with Licensees James and Carolyn Heinan and a copy of the report and appeal rights was provided.

Page 2 of 2.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20250306164216
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: 06/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
87625(b)(2)
1
2
3
4
5
6
7
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a written plan to ensure compliance with the section cited to LPA Kabariti by POC due date.
8
9
10
11
12
13
14
Based on interview, record review and observation the licensee did not ensure that staff checks and changes R1’s throughout the night resulting in R1 being left soiled throughout the night which poses an immediate health, safety and personal rights risk to persons in care.
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: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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
03/06/2025 and conducted by Evaluator Christine Kabariti
COMPLAINT CONTROL NUMBER: 26-AS-20250306164216

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:
06/20/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:James & Carolyn HeinanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not have sufficient staff to provide care and supervision to residents when a staff called in sick
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegations. LPA met with Licensees James and Carolyn Heinan.

On 03/06/2025, the Department received the complaint. On 03/13/2025, the initial complaint investigation was conducted. The following documents were received to include staff timecards, and resident (R1)'s physician's report, preplacement appraisal, appraisal/needs and services plan, identification and emergency contact information, and functional capabilities.

It was alleged that the facility did not have sufficient staff to provide care and supervision to residents when a staff called in sick the night of 02/27/2025. Page 1 of 2.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Christine Kabariti
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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-20250306164216
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: 06/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on staff interview, there were no call outs the night of 02/27/2025 – 02/28/2025. It was stated that if the facility staff do call out, they make sure another staff covers the shift.

The review of records did not indicate that there was a call out the night of 02/27/2025. The Licensees/owners of the facility, also covers the PM shifts but do not keep record of their timecard because they work 24/7. Staff denied there ever being a time where there were no staff at the facility.

Staff stated that R1 has a private caregiving agency who provides R1 morning care and nighttime activities of daily living care to include getting to and from bed, dressing, bathing, and incontinence care. The private caregiving agency starts their shift at 7:00am for morning care and returns from 4:30 – 5:00pm for nighttime care.

7 residents were interviewed. 7 out of 7 residents stated there is always staff available if needed. 7 out of 7 residents did not have any comments or concerns regarding the staffing ratio at the facility.

The Department has investigated the above allegations. Based on interview, record review and observation the above allegation is unfounded, meaning the allegation is 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: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5