445202756-4-13-2026-26-AS-CKAI-DTLLSV-20260429090123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 04/13/2026
Date Signed: 04/13/2026 03:22:15 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
10/30/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20251030133710

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:	04/13/2026
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	General Manager (GM) Candace Bolin		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure resident's incontinence needs were being met
Staff did not ensure resident had clean bedding
Staff did not ensure resident's showering needs were being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to deliver the findings of the complaint investigation received by the Department on 10/30/2025. LPA met with General Manager (GM) Candace Bolin. LPA stated the purpose of the visit.

It was alleged that staff did not ensure Resident R1’s incontinence needs were not being met on 10/20/2025.

The Department interviewed Reporting Party (RP) on 10/31/2025. RP stated he/she observed R1 to be soiled and needed to be changed on 10/20/2025. RP stated at the same time, a staff member came into the room. RP stated he/she thinks the staff was there to change the bedding. RP did not provide additional information.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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 6

Control Number 26-AS-20251030133710

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: 04/13/2026

NARRATIVE

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On 11/4/2025 the Department conducted the initial complaint investigation visit and interviewed 3 Staff (S1 to S3), and 4 Residents (R2 to R5).

The Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff stated he/she changes residents with incontinence more frequently than every 2 hours. S3 stated he/she was called to R1’s room for assistance. S3 did not remember the date of this incident. S3 stated he/she was called to R1’s room while he/she was passing medications, and it took him/her approximately 6 minutes to get to R1’s room. S3 stated he/she did not observe R1 to be soiled.

The Department interviewed 4 Residents (R2 to R5). 3 Out of 4 Residents stated he/she does not require toileting assistance from staff. R2 stated he/she did not know about staff assisting residents with toileting.

On 11/25/2025 the Department 2 additional staff (S4 and S5). S4 stated he/she was not working on 10/20/2025. S5 did not provide additional information regarding this incident.

Review of R1’s Physician’s Report dated 2/12/2023 states R1 can manage his/her own toileting needs, incontinence was not indicated/noted for R1.

Review of R1’s care plan dated 6/19/2025, R1 does not require assistance with toileting, and self manages his/her incontinence.

Staff did not ensure resident had clean bedding
The Department interviewed Reporting Party (RP) on 10/31/2025. RP stated he/she observed R1’s bedding to be soiled and needed to be changed on 10/20/2025. RP states at the same time, a staff member came into the room. RP stated he/she thinks the staff was there to change the bedding. RP did not provide additional information.

The Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff stated the facility has a laundry schedule, and each resident has a specific laundry day. S2 stated if residents have soiled items (clothing, bedding, etc), he/she will take the soiled items to the laundry for housekeeping to wash. S3 stated he/she was called to R1’s room for assistance on 10/20/2025.
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SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 26-AS-20251030133710

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: 04/13/2026

NARRATIVE

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S3 stated he/she was passing medications, and it took him/her approximately 6 minutes to get to R1’s room. S3 states he/she did not observe R1's bedding to be soiled.

The Department interviewed 4 Residents (R2 to R5). 4 Out of 4 Residents stated his/her bedding is changed/washed by the facility.

On 11/25/2025 the Department 2 additional staff (S4 and S5). S4 stated he/she was not working on 10/20/2025. S5 did not provide additional information regarding this incident.

Review of R1’s care plan dated 6/19/2025, R1 does not have additional laundry services besides what is included in rent. Per R1’s admission agreement dated 3/16/2022, R1's laundry is scheduled once a week.
Staff did not ensure resident's showering needs were being met
The Department interviewed Reporting Party (RP) on 10/31/2025. RP stated he/she is not sure if R1 was bathed and did not know R1’s shower schedule. RP stated it ‘appears’ that R1’s hair was 'greasy’ on 10/20/2025.

The Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff stated each resident has his/her own shower schedule and staff bathe resident’s according to the shower schedule. On 11/25/2025 the Department interviewed 2 additional staff (S4 and S5). S4 stated he/she was not working on 10/20/2025. S5 did not provide additional information regarding this incident.

The Department interviewed 4 Residents (R2 to R5). 3 Out of 4 Residents stated his/her bathing needs are being met. R3 stated he/she does not need assistance with bathing/showering.

Review of R1’s care plan dated 6/19/2025, R1’s ‘bathing frequency’ 1-2 times weekly and requires ‘hands-on assistance’ with bathing.

Although the allegation may have happened or is valid, there is no 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. An exit interview was conducted with GM, and a copy of this report was provided.
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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
10/30/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20251030133710

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:	04/13/2026
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	General Manager (GM) Candace Bolin		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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9

Staff did not inform resident's responsible party of resident's change in condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to deliver the findings of the complaint investigation received by the Department on 10/30/2025. LPA met with General Manager (GM) Candace Bolin. LPA stated the purpose of the visit.

The Department interviewed Reporting Party (RP) on 10/31/2025. RP stated the facility did not notify him/her about a change in condition of R1 from 10/10/2025 to 10/20/2025. RP states he/she observed R1’s on 10/20/2025 to be lying in bed, not doing well and R1’s eyes were ‘gooey and infected’ and had ‘conjunctivitis.’

The Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff state if a resident has a change in condition, he/she will document and inform the MedTech about the resident. S1 stated he/she would notify the MedTechs, family and Health Services Director if a resident had a change in condition.

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

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

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 26-AS-20251030133710

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: 04/13/2026

NARRATIVE

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On 11/25/2025 the Department 2 additional staff (S4 and S5). S4 stated he/she was not working on 10/20/2025. S2 statesd he/she did not see any documentation that R1’s physician was notified about R1 not feeling on 10/16/2025 and 10/19/2025. S5 stated R1 was assessed (vitals taken) by a MedTech on 10/16/2025 and 10/19/2025 when R1 stated he/she was not feeling well. S5 stated R1 was assessed at ‘baseline’ by a Medtech on 10/16/2025 and 10/19/2025. S5 states it is the responsibility of the Medtech to inform a resident’s physician about a change in condition. GM states on 10/16/2025, the physician was not notified due to the MedTech assessing R1 and determining R1 to be at ‘baseline.’

Review of R1’s progress notes dated 10/12/2025 to 10/25/2025, notes on 10/16/2025, a progress note category at 2:00PM ‘Alert Charting’ R1 was noted as ‘might be sick’. On 10/19/2025, a progress note category at 5:40AM ‘Change of Condition’ notes R1 to have change in bowel movements.

The Department requested documentation of the dates and times when R1’s responsible parties were notified about R1 not feeling well on 10/16/2025 and the change of condition noted on 10/19/2025. The facility was unable to provide documentation that R1’s responsible party and physician had been notified.

Review of R1’s emergency room discharge paperwork dated 10/20/2025 to 10/22/2025, R1 was noted with discharge on the eyelids, conjunctivitis was listed as one of the diagnoses.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be SUBSTANTIATED. California Code of Regulations (Title 22), are being cited on the attached LIC 9099 D. An exit interview was conducted with General Manager (GM) Candace Bolin and a copy of this report was provided. Appeal rights were also provided.

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 26-AS-20251030133710

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/20/2026 Section Cited CCR 87466	1 2 3 4 5 6 7	87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning...When changes such as... a physical health condition are observed, continued below	1 2 3 4 5 6 7	GM states she will submit a plan on how she will ensure resident's physicians and responsible parties are notified of any changes in a resident's physical, mental, emotional and social functioning. GM will submit POC by POC due date 4/20/2026.
	8 9 10 11 12 13 14	the licensee shall ensure that such changes..are brought to the attention of the resident's physician and the resident's responsible person, if any. This was not met as evidenced by:	8 9 10 11 12 13 14	Based on record reviews and interviews, the facility did not inform R1’s responsible parties of a change in condition on 10/16/2025 and 10/19/2025. This poses/posed a potential health, safety or personal rights risk to persons in care.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026

LIC9099 (FAS) - (06/04)

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