445202756-3-20-2025-26-AS-KHOS-DGLT3Y-20250512142306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 03/20/2025
Date Signed: 03/20/2025 01:58:47 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
02/27/2025 and conducted by Evaluator Manuel Monter

COMPLAINT CONTROL NUMBER: 26-AS-20250227150414

FACILITY NAME:	SUNSHINE VILLA ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	445202756
ADMINISTRATOR:	BOLIN, CANDACE		FACILITY TYPE:	740
ADDRESS:	80 FRONT STREET		TELEPHONE:	(831) 459-8400
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	132	CENSUS: 107	DATE:	03/20/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator Candace Bolin		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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The facility staff did not ensure that residents’ rooms are clean, safe, sanitary at all times.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcela Tarin and Manuel Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Administrator Candace Bolin

On February 27, 2025, The Department received a complaint alleging the facility staff did not ensure that residents’ rooms are clean, safe, sanitary at all times.

On February 27, 2025, the Department interviewed Witness W1. W1 stated his/her family members room is often not cleaned properly. W1 stated he/she noted issues such as feces in or on the toilet, trash on the floor and throughout the room, and the bed not being made regularly. W1 stated that he/she has reported these issues to the general manager, but no corrections have been made.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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)

Page: 1 of 3

Control Number 26-AS-20250227150414

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: SUNSHINE VILLA ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 445202756
	VISIT DATE: 03/20/2025

NARRATIVE

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On February 28, 2025, LPA Manuel Monter interviewed staff S1-S6. Staff S1-S6 stated the Housekeeper cleans residents bedrooms once a week. S1-S6 stated the care givers are supposed to maintain the rooms clean during the week.

5 Out of 6 staff interviewed (S2-S6) stated they have not seen any bedrooms that are not clean or unsanitary or rooms that clearly are neglected and need to be cleaned. Staff S1 stated he/she has seen residents’ rooms that aren’t clean. S1 stated from his/her memory, he/she has seen two bedrooms as dirty/ that have been neglected.

ADM stated resident bedrooms are cleaned weekly. ADM stated resident bedrooms Have assigned once a week housekeeping. ADM stated Care givers clean daily and remove trash each shift. ADM stated she has not seen any residents bedroom that were dirty, unclean or unsanitary.

On February 27, 2025, LPA Manuel Monter toured the facility assisted living section of the facility and randomly toured the following bedrooms: 105, 111, 143, 206, 207, 217, 226, 230, 309, 315, 321, 410, 412, 423, 425. While touring these bedrooms, LPA Monter observed the bedrooms as clean, safe and sanitary.

LPA Monter toured the following bedrooms in the memory care section of the facility: 1,3,5,7,9, 11. (Note all the bedrooms in the memory care are odd numbers by design.) LPA Monter observed the bedrooms as clean, safe and sanitary.

On March 14, 2025, LPA’s Manuel Monter and Marcella Tarin interviewed residents R1-R10. LPA’s attempted to interview resident R1, but R1 did not respond to LPA’s questions. R1 would digress to unrelated topics. 9 Out of 10 residents (R2-R10) stated they have no issues with the apartments cleanliness and stated their living space is clean.

LPA’s interviewed staff S7. Staff S7 stated housekeeping cleans residents’ bedrooms once a week. S7 stated If residents have an accident, then a care giver will clean the resident up and the area up. S7 stated, then housekeeping will come to sanitize the area as well. S7 stated he/she has not seen any resident bedrooms in an unclean/dirty state. S7 stated if he/she sees an accident in a residents bedroom, then he/she will notify staff to clean it up or he/she will clean it up herself. Page 2 Out of 3.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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)

Page: 2 of 3

Control Number 26-AS-20250227150414

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: SUNSHINE VILLA ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 445202756
	VISIT DATE: 03/20/2025

NARRATIVE

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On March 20, 2025, LPA Manuel Monter and Marcella Tarin toured the facility assisted living section of the facility and randomly toured the following bedrooms: 101, 103, 204, 218, 223, 247, 314, 333, 341, 345, 412, 414, 421. While touring these bedrooms, LPA Monter and Tarin observed the bedrooms as clean, safe and sanitary.

LPA Monter and Tarin toured the following bedrooms in the memory care section of the facility: 1,3,5,7,9, 11. LPA Monter and Tarin observed the bedrooms as clean, safe and sanitary.

Based on investigation, interviews conducted and records reviewed , the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Page 3 Out of 3. END OF REPORT.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
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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