445202597-10-24-2023-26-AS-KHOS-CY22NA-20231128163224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202597
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:44:27 PM

Unfounded

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
09/30/2020 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20200930112546

FACILITY NAME:	WESTWIND MEMORY CARE		FACILITY NUMBER:	445202597
ADMINISTRATOR:	KAREN TRAVIS		FACILITY TYPE:	740
ADDRESS:	160 JEWELL STREET		TELEPHONE:	(831) 421-9100
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	59	CENSUS:	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Steven Silacci		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not sufficient in numbers or competency to meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Steven Silacci.

The Department received a complaint with the above allegation on 09/30/2020 and conducted an initial complaint visit on 10/12/2020. The Department conducted an additional complaint investigation visit on 08/23/2023.

During visit on 08/23/2023, LPA Marrufo conducted interviews with Administrator Steven Silacci and requested to interview staff who were employed when the complaint allegation was reported, which was 09/2020. Administrator Silacci brought 7 staff, staff S1-S7, for LPA Marrufo to interview. Administrator Silacci and staff S1-S5 reported working with resident R1. However, staff S4 provided care to R1 but did not provide medications and S5 did not provide care to R1. See LIC9099-C for more information. Page 1 of 2.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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 2

Control Number 26-AS-20200930112546

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: 10/24/2023

NARRATIVE

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During interview on 08/23/2023, facility staff S1 stated that resident R1 had a behavior of running throughout the facility. S1 stated the facility policy regarding use of anti-anxiety PRN medications is for staff to attempt a redirection first before administering any anti-anxiety PRN medications. S1 stated that this policy was followed with R1 when R1 would run throughout the building.

S1-S4 stated staff would attempt to redirect R1 before administering anti-anxiety PRN medications. S1 also stated during that time, there were always sufficient staff at the facility. Staff S5 stated to have provided redirections to R1 but did not have knowledge as to whether or not R1 was given anti-anxiety PRN medications. Staff S6-S7 stated to have not worked with R1.

Staff S1, S2, S3, S6, S7 stated that there were enough staff at the facility to meet the residents’ needs in the year 2020. Staff S4 and S5 stated that there were many staff shortages due to the COVID pandemic at that time.

Facility Staff Schedules from July and August 2020 show a full schedule of staff.

R1’s Physician’s Orders from 12/08/2020 state Lorazepam is a PRN medication for R1 to be used as needed for anxiety.

R1’s PRN Medication Log from 12/2020 records the interventions given prior to administering Lorazepam medication for anxiety. The interventions include “One on one,” “Music,” “Visited with Resident,” and “Photo Albums.”

This agency has investigated the complaint allegations listed. Based on interviews and 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 Steven Silacci and a copy of the report was provided.

Page 2 of 2. END REPORT.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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