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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202597
Report Date: 10/31/2023
Date Signed: 10/31/2023 11:21:55 AM

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
10/09/2020 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20201009161515
FACILITY NAME:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:KAREN TRAVISFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: 49DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Steven SilacciTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility mismanaged residents medications.
Facility did not coordinate care with hospice agency.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Steven Silacci, Administrator.

The Department received a complaint on 10/09/2020. The complaint made the following allegations: facility staff were not administering resident R1’s new order for Naproxen and order for Lorazepam; Resident R2 was found with morphine medication tablets on R2’s pillow and R2’s liquid Roxanol order had not been started; facility staff administered R3’s comfort pack medications without receiving an order from R3’s hospice agency; facility staff were unable to explain to R2’s hospice agency how much of the PRN Phenobarbital orders staff had administered to R2, causing difficulty for the hospice agency to appropriately titrate scheduled medication; facility staff did not conduct regular checks on R4 to ensure R4 was not ingesting and covered with R4’s own feces.

See LIC9099-C for more information. Page 1 of 3.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
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 7
Control Number 26-AS-20201009161515
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
VISIT DATE: 10/31/2023
NARRATIVE
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The Department conducted an initial complaint visit on 10/19/2020 and conducted additional complaint investigation visits on 07/09/2021, 08/23/2023, 10/03/2023, and 10/24/2023.

R2’s Charting Notes from 07/11/2020 at 6:47 PM states, “Family member found medication of resident on the floor, family member asked if it could be crushed so it could be administered, explained it could not due to label specifications/instructions.”

R3’s Hospice Team Care Plan indicates that R3 had a comfort pak that included orders to give 0.25 ml of Morphine Sulfate, Lorazepam 0.5 mg tablet every 6 hours for PRN for anxiety or agitation, and to call the hospice agency to initiate any comfort pak medication.

R3’s Charting Notes entry from 01/08/2020 at 5:52 AM indicate that staff administered PRN of morphine to R3; the entry does not indicate if hospice was notified. R3’s Charting Notes from 01/08/2020 at 3:00 PM states, “[R3’s spouse] requests that we give small (0.25 ML) dose of morphine during waking hours and only use (0.5ML) dose during the night.” R3’s Charting Notes entry from 10/12/2020 2:00 PM stated R3 was given 0.25 ML of morphine and 0.5 MG of Lorazepam, but there is no statement about if the hospice agency was contacted prior to administering the comfort pak medications.

On 10/24/2023, LPA Marrufo interviewed facility staff S1. During interview, S1 stated that staff are supposed to log that they have contacted the hospice care agency prior to initiating a comfort pak. S1 stated staff are not to take medication orders from families.

On 10/03/2023, LPA Marrufo interviewed facility staff S2. During interview, S2 stated to have the job role as medication technician at the facility and was trained for almost two months in that role. S2 stated that before administering comfort paks, facility staff have to call the hospice agency and let the hospice agency know the resident’s condition. S2 stated the hospice agency will then let the staff know if the resident can use the comfort pak, which medication, and the dosage. S2 stated staff are supposed to chart the phone call with hospice care in the Medication Administration Record (MAR) in the resident’s chart notes. S2 stated if a family member asked if a resident could receive a comfort pak, staff would still need to contact the hospice agency first before administering the comfort pak.

Page 2 of 3.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 26-AS-20201009161515
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
VISIT DATE: 10/31/2023
NARRATIVE
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LPA Marrufo obtained copies of R5 and R6s Charting Notes. The Charting Notes for R5 from 07/18/2023 and for R6 on 09/09/2023 both indicate that staff contacted the hospice agency prior to administering comfort paks.

R2’s Charting Notes from 07/09/2020 at 5:34 AM states, “Before 3:30 am [R2] was pacing the hallways and a little agitated. Gave PRN.” The Charting Notes entry does not indicate which PRN was administered to R2 and if the hospice agency was notified.

Based on records review and interviews, there is preponderance of evidence to prove the alleged violations did occur. Therefore, the allegations are substantiated.

See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

This report was reviewed with Steven Silacci and a copy of the report and appeal rights were provided.



Page 3 of 3.

END REPORT
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 26-AS-20201009161515
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/01/2023
Section Cited
CCR
87465(h)(B)
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Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed.
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Licensee shall submit a Plan of Correction by POC date to ensure that staff receive in-service training on securing medications and not leaving medications unsecured in resident living units. Once training is completed, the Licensee agrees to submit training logs to CCL.
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This requirement was not met as evidenced by: Licensee did not ensure that R2 did not have unsecured medication in R2’s living unit, which poses an immediate safety risk to residents in care.
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Type A
11/01/2023
Section Cited
CCR
87633(d)
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87633(d) Hospice Care of Terminally Ill Residents (d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times.
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Licensee shall submit a Plan of Correction by POC date to ensure that facility staff will receive in-service training on contacting the hospice agency prior to administering comfort paks to residents as directed in the resident’s hospice care team plan.
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This requirement was not met as evidenced by: Licensee did not ensure that staff followed R3’s hospice care plan by contacting R3’s hospice agency before administering comfort paks to R3.
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Once training is completed, the Licensee agrees to submit training logs to CCL.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
10/09/2020 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20201009161515

FACILITY NAME:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:KAREN TRAVISFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: 49DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Steven SilacciTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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2
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Staff did not follow physician's orders
INVESTIGATION FINDINGS:
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R1’s medication logs state R1’s prescription for Naproxen was discontinued on 07/13/2020. The medication logs indicate R1 was last administered Naproxen on 07/11/2020 at 8:00 AM. The medication log entries for 07/12-13/2020 state that facility staff did not administer Naproxen because the facility was “Awaiting for Clarification.”
The medication logs state from 07/12-19/2020 state R1 was physically unable to swallow medications and passed away on 07/20/2020. The log entries for 07/21/2020 state R1 was unable to take Lorazepam because the resident had passed away.

This agency has investigated the complaint allegation listed. Based on review of records, the CCLD has found that the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This report was reviewed with Adminstrator Steven Silacci and a copy of the report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
10/09/2020 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20201009161515

FACILITY NAME:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:KAREN TRAVISFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: 49DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Steven SilacciTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not meet hygiene needs of resident.
INVESTIGATION FINDINGS:
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R4’s Charting Notes do not mention R4 ingesting or being covered in R4’s own feces.

R4’s Resident Service Plan did not mention any behaviors involving inappropriate interaction with feces.

LPA Marrufo obtained R4’s Move-In Form and attempted to contact R4’s spouse to conduct an interview on 10/03/2023, but the telephone number was disconnected.
On 10/24/2023, LPA Marrufo interviewed S3. During interview, S3 stated R4 had a behavior of handling and spreading R4’s own feces on the walls and ingesting R4’s own feces. S3 stated staff conducted frequent checks on R4 to prevent R4 from being covered in and ingesting R4’s own feces. S3 stated the staff frequently checked on R4 every 30-60 minutes.

See LIC9099-C for more information. Page 1 of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 26-AS-20201009161515
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
VISIT DATE: 10/31/2023
NARRATIVE
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S3 stated staff would also divert R4’s attention with various activities to prevent R4’s behaviors with feces. S3 stated to not remember if there was a time when facility staff were told R4 had ingested feces but staff did not respond.

Administrator Steven Silacci stated S3 is the only staff at the facility who worked with R4 and is still employed at the facility.

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

No Deficiencies cited under California Code of Regulations Title 22

This report was reviewed with Steven Silacci and a copy of this report was provided.

Page 2 of 2.



END REPORT
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7