440708773-11-6-2024-26-AS-KHOS-DCJSA4-20250102124143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 440708773
Report Date: 11/06/2024
Date Signed: 11/06/2024 06:04:58 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
06/19/2024 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20240619144408

FACILITY NAME:	DOMINICAN OAKS		FACILITY NUMBER:	440708773
ADMINISTRATOR:	KATHERINE WILL		FACILITY TYPE:	740
ADDRESS:	3400 PAUL SWEET ROAD		TELEPHONE:	(831) 462-6257
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95065
CAPACITY:	142	CENSUS: 46	DATE:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Amy Saulnier		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff speaks inappropriately to a resident
Staff do not ensure that a resident's toileting needs are met
Staff do not ensure that residents are served food of good quality

INVESTIGATION FINDINGS:

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LPA Marrufo conducted an unannounced complaint investigation visit and met with Administrator Amy Saulnier. On 06/19/2024, the Department received a complaint with the above allegations. On 06/28/2024, LPA Simi Rai conducted an initial complaint investigation visit. LPA Marrufo conducted additional complaint investigation visits on 08/01/2024 and 10/29/2024.

During the investigation, LPA Marrufo obtained a copy of resident and facility records and interviewed staff, residents, and a resident’s family member.

During interview on 08/01/2024, resident R1 stated that staff S1 would tell R1 to pick fallen items from the ground himself/herself and that R1 was “the bottom of the barrel.”

See LIC9099-C for more information. Page 1 of 5.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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-20240619144408

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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During interview on 08/01/2024, S1 stated to have never spoken inappropriately to R1. Staff S2 and S4-S6 stated to have never observed S1 speak inappropriately to R1.

During interview on 10/18/2024, S3 stated that R1 complained to S3 that R1 asked S1 to pick up an item from the floor and S1 refused.

During visits on 08/01/2024 and 10/29/2024, LPA Marrufo interviewed an additional 13 residents. 1 out of 13 interviewed residents stated to have observed a staff speak inappropriately to residents but did not provide the name of the staff. 12 out of 13 interviewed residents stated to have not observed staff speak inappropriately to residents.

Family Member FM1 stated in a written statement to LPA Marrufo on 07/21/2024 that on 03/13/2024, S1 left R1 on the toilet, left R1’s room, and told R1 to call S1.

During interview on 10/21/2024, resident R1 stated that S1 assisted R1 to the toilet and while R1 was on the toilet, S1 told R1 that S1 had to go to another apartment and would be right back. R1 stated that R1 was left alone on the toilet for approximately 10 minutes. R1 stated S1 returned to R1 and assisted R1 off the toilet. R1 stated to not remember if there were more times S1 left R1 on the toilet.

R1’s Physician’s Report completed on 02/09/2023 states R1 is able to care for his/her own toileting needs with assistance and states R1 is ambulatory.

R1’s Physician’s Report completed on 05/06/2024 states R1 is not able to care for his/her own toileting needs and states R1 is non-ambulatory.

R1’s Physician’s Report completed on 10/08/2024 states R1 is able to care for his/her own toileting needs and states R1 is ambulatory.

Page 2 of 5.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 26-AS-20240619144408

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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The Toileting Section on page 14 of the Employee Handbook states, “1. Escort the resident to the toilet. Provide transfer assistance as necessary. Provide privacy. 2. If appropriate and safe, step out of the bathroom. a. If your community uses call lights be sure it is within the resident’s reach. b. If not, stay nearby so the resident may call out to you when he/she is finished. c. Never leave a resident alone on the toilet for a long period of time.”

During visit on 10/29/2024, LPA toured R1’s living unit. LPA observed emergency pull cords in R1’s bathroom near R1’s toilet and in R1’s bedroom. LPA observed R1 was not wearing an emergency pendant necklace. R1 stated not to own an emergency pendant necklace. LPA Marrufo pulled the emergency pull cord in R1’s bathroom and a staff responded to the pull cord in 2 minutes and 25 seconds.

LPA Marrufo obtained a copy of the Assisted Living Residential Care Conference that S2 wrote on 03/12/2023. The document records a conference between S2, FM1, and R1. The document Comments section states, “Explained that staff are task oriented and will be able to provide care at scheduled times + as needed. Also, explained that wait periods are not unusual, as staff are trained to complete the task they are involved with before moving on to another resident request. Wait periods could range from 5min-30minutes. Res. acknowledged + seemed to accept that there may be times when [R1] will be on [R1’s] own and staff will come to provide care on a schedule established upon move-in. Informed [R1] and [FM1] that we do not have a large staff to provide 1:1 companion care or extended periods of time to complete resident tasks outside of bathing, dressing, toileting, + escorts.”

R1’s Family Member (FM1) sent LPA Marrufo an email on 07/21/2024 stating that FM1 spoke with staff S2 on 02/20/2024. FM1 stated that S2 stated that staff are allowed to leave a resident on the toilet and leave the apartment. FM1 stated S2 stated that staff are not going to wait 20 minutes for a resident to defecate.

During interview on 08/01/2024, S1 stated to have never left R1 on the toilet for a long period of time. S1 stated the staff are not supposed to do that.

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SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 26-AS-20240619144408

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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During interview on 08/01/2024, staff S4 stated that R1 complained to S4 that S1 left R1 on the bathroom. S4 stated to have reported R1’s complaint to S4’s supervisor and management.

During interview on 08/01/2024, S2 stated that R1 reported that R1 was left on the toilet for a long time, but S2 did not witness the incident. S2 stated that S1 stated to have told R1 that S1 needed to step out and would come back and that R1 agreed to have S1 leave. S2 stated to not recall why S1 stated S1 needed to step out.

During interview on 10/01/2024, staff S1 stated to have never left R1 on the toilet and walked out of R1’s apartment. S1 stated to have only stepped out of R1’s bathroom when R1 requested privacy. S1 stated S1 would stay outside R1’s bathroom door and would enter the bathroom again when R1 told S1 that R1 was ready for S1 to enter the bathroom again.

During interview on 10/18/2024, staff S3 stated that R1 told S3 that S1 told R1 that S1 was busy and left R1 on the toilet for more than half an hour. S3 stated to have remembered at least three other times that R1 told S3 that S1 left R3 on the toilet. S3 stated that when S3 has assisted R1 on the toilet and received a call to assist another resident, S3 has called another staff to assist the other resident. S3 stated to have never left R1’s apartment while R1 was on the toilet.

During interview on 10/21/2024, FM1 stated to have been walking towards R1’s apartment and came across S1 in the hallway to R1’s apartment. FM1 stated that S1 told FM1 that R1 was on the toilet and it way “okay” for S1 to leave to go next door to help a neighboring resident.

During visits on 08/01/2024 and 10/29/2024, LPA Marrufo interviewed 13 additional residents. 5 out of 13 interviewed residents stated to have no need for toileting assistance from staff. 7 out of 13 interviewed residents stated that staff ensure their toileting needs are met. 1 out of 13 interviewed residents stated that staff have left him/her on the toilet for 10 minutes before returning to continue assisting the resident on the toilet. The resident stated that the staff who left him/her was not S1.

Page 4 of 5.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 26-AS-20240619144408

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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LPA Marrufo obtained facility invoices for purchases of fruits and vegetables for the following dates: 04/24/2024, 05/01/2024, 06/05/2024, and 06/24-28/2024.

On 08/01/2024, LPA Marrufo observed meal services and interviewed 14 residents. 12 out of 14 interviewed residents stated to like the food at the facility. 2 out of 14 interviewed residents stated to not like the food at the facility. 12 out of 14 interviewed residents stated to have never been served spoiled fruits or vegetables. 2 out of 14 interviewed residents stated to have been served spoiled fruits or vegetables. LPA did not observe any foods that did not appear to be of good quality during meal service, including spoiled fruits or vegetables. LPA toured the facility kitchen and observed the food supplies, including the supplies of fruits and vegetables in the walk-in refrigerator.

On 08/01/2024, LPA interviewed 5 staff. 5 out of 5 interviewed staff stated that the food is of good quality, and they have never observed staff be served spoiled fruits or vegetables.

On 10/29/2024, LPA Marrufo interviewed 7 additional residents. 6 out of 7 interviewed residents stated that they think the facility food is of good quality. 1 out of 7 interviewed residents stated he/she thinks the facility food is not of good quality. 7 out of 7 interviewed residents stated to have not been served spoiled fruits or vegetables.

An Advisory Note was issued. See LIC9102 for more information.

Based on information from interviews conducted with staff, residents, and a family member of a resident, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22

This report was reviewed with Administrator Amy Saulnier and a copy of this report was provided.

Page 5 of 5. END REPORT.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

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