<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 01/15/2026
Date Signed: 01/15/2026 03:43:39 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
03/14/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250314154957
FACILITY NAME:SUNSHINE VILLA ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
445202756
ADMINISTRATOR:BOLIN, CANDACEFACILITY TYPE:
740
ADDRESS:80 FRONT STREETTELEPHONE:
(831) 459-8400
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:132CENSUS: 102DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:General Manager (GM) Candace BolinTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not administer resident medication as prescribed.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a complaint investigation visit to deliver the complaint findings. LPA met with General Manager (GM) Candace Bolin and stated the purpose of the visit.

On 3/14/2025 the Department received a complaint with the above allegations.

On 3/18/2025 the Department interviewed the Reporting Party (RP). RP states the facility ‘misplaced’ resident (Referred to as R1) medication causing R1 to go without medication for at least one day. RP stated R1’s palliative agency mailed R1’s medication to the facility on 3/7/2025. RP states he/she ‘assumes’ the facility signed for the medication but states he/she does not have any documentation that the medication was received by the facility from the palliative agency on 3/7/2025.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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 5
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
03/14/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250314154957

FACILITY NAME:SUNSHINE VILLA ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
445202756
ADMINISTRATOR:BOLIN, CANDACEFACILITY TYPE:
740
ADDRESS:80 FRONT STREETTELEPHONE:
(831) 459-8400
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:132CENSUS: DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:General Manager (GM) Candace BolinTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained skin tear due to staff neglect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a complaint investigation visit to deliver the complaint findings. LPA met with General Manager (GM) Candace Bolin and stated the purpose of the visit.

On 3/14/2025 the Department received a complaint with the above allegation.

On 3/18/2025 the Department interviewed the Reporting Party (RP). RP states R1 had a skin tear due to adhesive, and sweating. R1 states the skin tear was not a pressure injury.

On 3/20/2025, 4/4/2025 and 10/7/2025 the Department conducted complaint investigation visits.


Page 1 of 2
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20250314154957
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: 01/15/2026
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
 The Department interviewed 7 Staff (S1 to S7), 8 Residents (R1 to R8) and 1 Witness (W1). 7 Out 7 staff state he/she is not aware of any residents sustaining a skin tear due to staff neglect. S4 states residents have ‘fragile skin.’

On 3/20/2025, 4/4/2025 and 10/7/2025 the Department interviewed 8 Residents (R1 to R8). 5 Out of 8 Residents stated he/she has no issues/concerns with staff. R3 did not respond to questions due to neurocognitive disorder. R7 and R8 declined to be interviewed



On 3/20/2025, 4/4/2025 and 10/7/2025 the Department interviewed Witness 1 (W1). W1 states he/she has no issues with facility.

Review of R1’s care plan dated 3/3/2025, under Skin Evaluation, R1 is noted to have ‘dry skin, ‘requires assistance with lotion to extremities.” Review of R1’s progress notes for 3/13/2025 state a Care Conference was held with R1, palliative care and R1’s responsibly party regarding ‘skin breakdown, potentially caused by the adhesive tape on briefs…facility will trial pull-up briefs.”

This agency has investigated the complaint alleging that a resident sustained skin tear due to staff neglect. We have found that the complaint was UNFOUNDED meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted with General Manager (GM) Candace Bolin. A signed copy of this report was provided.

Page 2 of 2

END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 26-AS-20250314154957
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: 01/15/2026
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
On 3/20/2025, 4/4/2025 and 10/7/2025 the Department interviewed 8 Residents (R1 to R8). 5 Out of 8 Residents stated staff have never handled him/her in a rough manner. R3 did not respond to questions due to neurocognitive disorder. R7 and R8 declined to be interviewed.

On 3/20/2025, 4/4/2025 and 10/7/2025 the Department interviewed Witness 1 (W1). W1 states he/she has no issues with facility.

Review of R1’s progress notes for 3/16/2025 note an incident on 3/14/2025 that two staff from palliative care arrived for R1 at approximately 9:30PM. The Progress note states a Medtech, and two staff from palliative care provide care, during which R1 was repositioned onto his/her right side, and then onto his/her back. R1 noted to be upset during this incident. Management was notified of the incident. No injuries were noted during this incident.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.



No deficiencies were cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with GM Candace Bolin and a signed copy of this report was provided.

Page 3 of 3
END OF REPORT
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 26-AS-20250314154957
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: 01/15/2026
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
On 3/20/2025, 4/4/2025 and 10/7/2025 the Department conducted complaint investigation visits.

The Department interviewed 7 Staff (S1 to S7), 8 Residents (R1 to R8) and 1 Witness (W1). 5 Out 7 staff state residents are administered medications as prescribed. S1 states there was an issue with medications not being faxed to the pharmacy for R1, “medication list got lost in the fax server,” which resulted in R1’s medication not being administered. S3 states he/she has observed staff not administering medication to a resident as prescribed. S3 states this incident was reported to management sometime in June/July 2025.

On 1/15/2026 LPA interviewed S1. S1 states the facility did not receive R1's medications from palliative care on 3/7/2025 due to the palliative agency mailing the medications to R1's home instead of the facility. S1 states this incident was noted on R1's progress notes.

Review of R1's progress notes for 3/8/2025 notes the facility requested R1's medications from the palliative agency.

On 3/20/2025, 4/4/2025 and 10/7/2025 the Department interviewed 8 Residents (R1 to R8). 5 Out of 8 Residents stated he/she receives medications as prescribed. R3 did not respond to questions due to neurocognitive disorder. R7 and R8 declined to be interviewed.

On 3/20/2025, 4/4/2025 and 10/7/2025 the Department interviewed Witness 1 (W1). W1 states he/she has no issues with facility, and if he/she has issues facility management will address.

Staff handled resident in a rough manner

On 3/18/2025 the Department interviewed the Reporting Party (RP). RP states R1 was handled in a rough manner by staff on 3/15/2025.

On 3/20/2025, 4/4/2025 and 10/7/2025 the Department conducted complaint investigation visits. The Department interviewed 7 Staff (S1 to S7), 8 Residents (R1 to R8) and 1 Witness (W1). 7 Out 8 staff state he/she has not observed staff handling residents in a rough manner. S3 states he/she heard R1 yell as he/she was passing R1’s room, and S3 observed staff from an outside agency transfer R1 without explaining the transfer process. S3 states he/she checked on R1 and R1 stated the staff hurt him/her. S3 states he/she informed Medtech on duty but did not provide any additional information.

Page 2 of 3

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5