445202597-3-20-2025-26-AS-RMAO-DF6S8Y-20250327133952

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202597
Report Date: 03/20/2025
Date Signed: 03/20/2025 03:29:53 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
01/09/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250109132853

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: 52	DATE:	03/20/2025
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Administrator Steven Silacci		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff restricted resident's airway, resulting in resident losing consciousness

INVESTIGATION FINDINGS:

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On 01/9/2025 the Department received a complaint alleging that staff restricted resident’s airway causing the resident to lose consciousness on 1/8/2025. It has been alleged that staff S7 pinched resident R1’s nose causing R1 to lose consciousness.

On 1/10/2025, the Department investigated the alleged incident that occurred on 1/8/2025 wherein the incident involves a resident (referred to as R1), who was in an agitated state. R1 was having behaviors, while holding a statue of a crane, while screaming, yelling and moving toward staff in an aggressive manner at approximately 7AM. Staff members (referred to as S1 to S7) were able to intervene and deescalate situation and eventually, R1 remained calm and able to redirect by staff.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250109132853

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: 03/20/2025

NARRATIVE

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During the Department’s investigation, on 1/21/2025 and 1/23/2025, 7 staff were interviewed. 5 Out of 7 staff did not observe R1’s nose pinched by S7 on 1/8/2025 when R1 was having behaviors while 2 Out of 7 staff state they observed R1’s nose being pinched by staff S7. 7 Out of 7 staff state R1 was having behaviors on 1/8/2025, where R1 was in an agitated state, screaming, yelling, and moving toward staff. These two staff members who observed the alleged abuse by a staff pinching R1’s nose also noted it caused R1 to lose consciousness.

S7 stated on 1/8/2025 he/she was in the hallways when he/she observed R1 agitated and being aggressive with staff. S7 states he/she went over to help de-escalate and calm R1 by speaking calmly to R1 and only touching his/her shoulders to re-direct. S7 states it took 30 seconds to calm down R1. S7 denies pinching R1’s nose.

On 1/18/2025 and 2/18/2025, the Department interviewed 5 residents (referred as R1 to R5) during the investigation. 4 Out of 5 residents state they did not observe a staff pinch R1’s nose. 1 Out of 5 residents (R1) stated his/her nose was “grabbed” by a staff described as a “heavy girl” but could not identify any of the staff involved in the incident. R1 states the incident occurred three weeks ago.

On 1/23/2025, the Department conducted an interview with ADM regarding the allegation. ADM states on 1/13/2025, an internal investigation was conducted by the facility. ADM states he/she conducted interviews with 7 staff S1 to S7 wherein staff recollection of the incident made inconsistent statements. Due to insufficient evidence, the facility was unable to substantiate the allegation that R1’s nose was pinched by a staff on 1/8/2025.

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SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250109132853

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: 03/20/2025

NARRATIVE

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The Department obtained R1’s Physician’s report and Appraisal Needs and Services Plan (ANS). During a review of R1’s Physician’s Report dated 12/20/2024, R1’s mental condition is associated with confusion, disorientation, and is sometimes able to follow directions and has major neurocognitive disorder. R1’s ANS dated 12/24/2024 states R1 requires “ongoing assistance with care…with speech, functional and behavioral impairments due to disoriented to person/time/place….” and R1’s needs moderate assist with “interventions and care coordination to de-escalate negative behaviors.”

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 Administrator Steven Silacci and a copy of this report was provided.

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

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