445202756-11-9-2024-26-AS-KHOS-DAXT56-20241112132501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 11/09/2024
Date Signed: 11/09/2024 02:32:00 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
05/27/2022 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220527131408

FACILITY NAME:	SUNSHINE VILLA ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	445202756
ADMINISTRATOR:	MCKIE, JAMES		FACILITY TYPE:	740
ADDRESS:	80 FRONT STREET		TELEPHONE:	(831) 459-8400
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	132	CENSUS: 107	DATE:	11/09/2024
		UNANNOUNCED	TIME BEGAN:	10:33 AM
MET WITH:	Jennifer Gleitsmann		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff is neglecting to assist residents during falls.
Facility is not quarantining COVID-19 positive residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 11/09/2024 at 10:30 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee met with Community Relation Assistant Jennifer Gleitsmann and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 107. A brief interview with conducted with Jennifer Gleitsmann.

Allegation were made that facility staff is neglecting to assist residents during falls. The investigation involved a review of records and interviews with residents and staff. LPA Lee reviewed the facility’s operational plan and confirmed that a fall prevention plan is in place. Interviews were conducted with all 7 residents, who expressed no concerns regarding staff neglecting to assist residents during falls. Residents also reported witnessing staff assisting another resident who had fallen. Additionally, LPA Lee interviewed all 3 staff members, each of whom denied the allegations. Based on statements obtained during the investigation process, LPA was unable to corroborate the allegation that facility staff is neglecting to assist residents during falls.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

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-20220527131408

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: 11/09/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation were made that the facility is not quarantining residents who test positive for COVID-19. The investigation included a review of records and interviews with residents and staff. The facility's Mitigation Plan, dated January 14, 2021, was also reviewed and is within the CDC guidelines. LPA Lee interviewed all 7 residents, none of whom expressed concerns about the facility's quarantine practices for COVID-19 positive residents. Residents indicated that those who test positive are required to quarantine in their rooms. Additionally, LPA Lee spoke with all 3 staff members, who confirmed that the facility adheres to CDC guidelines and denied the allegation. Based on the interviews and evidence collected during the investigation, LPA Lee was unable to corroborate the allegation that facility is not quarantining residents who test positive for COVID-19.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2