445202597-9-19-2024-26-AS-KHOS-D9LVJG-20240930162843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202597
Report Date: 09/19/2024
Date Signed: 09/19/2024 04:14:36 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
08/23/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220823091905

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: 55	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Steven Silacci		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility did not ensure that residents had access to assistive devices while in care resulting in falls.

INVESTIGATION FINDINGS:

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On 9/19/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director, Steven Silacci and explained the purpose of today's visit.

Regarding the allegation of facility did not ensure that residents had access to assistive devices while in care resulting in falls, Reporting Party (RP) stated that Assistive devices not in place per care plan, or implemented timely, both resulting in resident falls.

LPA interviewed the ED and it was mentioned that the facility has no bed alarms. All the residents needs are addressed in the care plan like constant status checks.

LPA Heberle also interviewed 2 staff members. S1 stated that there's 4 staff on 2nd floor per shift and about 3 on the first floor per shift. Thinks that staff is very capable on how to lift and they always have enough people to assist residents as needed. Has definitely received adequate training, receives training that they are tested on monthly.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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-20220823091905

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: 09/19/2024

NARRATIVE

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Based on records review, according to a service plan on one of the residents (R1), there is an Increased Risk for Fall so staff to provide assistance in the case of a fall. Fall prevention program is in place. Meaning, as explained by ED and WD (Wellness Director), constant status checks and facility has enough staff to continuously do check on resident.

Based on interviews and records review, the department has determined that although the allegation 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.

Report is reviewed and copy is provided.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

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