445202597-11-8-2023-26-AS-KHOS-D92PZE-20240912114524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202597
Report Date: 11/08/2023
Date Signed: 11/08/2023 10:22:14 AM

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
08/15/2023 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20230815113903

FACILITY NAME:	WESTWIND MEMORY CARE		FACILITY NUMBER:	445202597
ADMINISTRATOR:	STEVEN SILACCI		FACILITY TYPE:	740
ADDRESS:	160 JEWELL STREET		TELEPHONE:	(831) 421-9100
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	59	CENSUS: 49	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Parvendar Kaur		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff were having inappropriate interactions in the presence of a resident.
Staff did not report unusual incident to a resident's representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Parvendar Kaur, Wellness Director.

On 08/15/2023, the Department received a complaint investigation with the above allegations. LPA Marrufo conducted an initial complaint investigation visit on 08/23/2023 and conducted an additional visit on 10/03/2023.

During visit on 08/23/2023, LPA Marrufo interviewed 16 facility staff. 16 out of 16 staff stated to have not observed any inappropriate interactions

On 08/23/2023, LPA Marrufo made a telephone call to staff S1 to conduct an interview, but S1 refused to be interviewed. See LIC9099-C for more information. Page 1 of 2.

Unsubstantiated

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: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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-20230815113903

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: 11/08/2023

NARRATIVE

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On 10/20/2023, LPA Marrufo conducted a telephone interview with staff S2. During interview, S2 denied having any inappropriate interactions with another staff, including staff S3.

LPA Marrufo attempted to conduct telephone interviews with S3 on 08/15/2023, 10/20/2023, and 11/07/2023, but was not able to reach S3.

During interview on 08/23/2023, Administrator Silacci stated to have interviewed S2 and S3 separately and both S2 and S3 denied having had any inappropriate interactions in the presence of a resident or in the facility.

During interview on 10/03/2023, Administrator Silacci stated to have asked S2 and S3 what they were doing in a resident room together, and S2 and S3 stated to have been assisting residents together in the residents’ rooms.

Based on information from interviews conducted with staff, 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 were cited under California Code of Regulations Title 22.

This report was reviewed with Parvendar Kaur, Wellness Director, and a copy of this report was provided.

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END REPORT

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2