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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 04/24/2026
Date Signed: 04/24/2026 01:56:41 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
09/08/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250908083929
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: 108DATE:
04/24/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:General Manager (GM) Candace BolinTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility staff did not ensure that resident's room was maintained clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to deliver the findings of the complaint investigation. LPA met with General Manager (GM) Candace Bolin. LPA stated the purpose of the visit.

On 9/8/2025 the Department received a complaint with the above allegation.

On 9/8/2025 the Department interviewed the Reporting Party (RP). RP states on 9/2/2025 and 9/3/2025 he/she observed a resident, referred to as R1, room to not be clean. RP states he/she placed a trash can next to the area that needed to be clean, for facility staff to notice the area. RP states he/she did not inform facility staff that an area of the room needed to be cleaned. RP states he/she emailed facility management regarding this incident on 9/3/2025.

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

DATE: 04/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026
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 2
Control Number 26-AS-20250908083929
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: 04/24/2026
NARRATIVE
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On 9/10/2025 the Department conducted the initial complaint investigation visit and interviewed General Manager (GM) Candace Bolin, 3 Staff (S1 to S3), 9 Residents (R2 to R9). GM states each resident has his/her own housekeeping schedule per his/her care plan. GM states she was notified by RP on 9/4/2025 that an area in R1's room needed to be cleaned. GM states housekeeping cleaned the area in R1's room on 9/4/2025.

On 9/10/2025 the Department interviewed 3 Staff (S1 to S3). 3 Out of 3 staff state he/she has not observed a resident's room to not be maintained clean. 3 out of 3 staff state he/she will clean a resident's room when needed.

On 9/10/2025, the Department interviewed 9 Residents (R2 to R10). 9 Out of 9 residents stated he/she has housekeeping once a week.

Review of R1's care plan dated 3/25/2025, R1 does not have additional housekeeping services 'outside what is included in rent."

On 4/24/2026, GM states included in each resident's admission agreement is 1 scheduled laundry service, additional laundry services can be included for a fee in the plan if a resident chooses.

On 9/10/2025, the Department inspected 10 resident rooms (102, 103, 105, 107, 111, 115, 227, 225, 223, and 219) and observed all 10 resident rooms to be clean, safe and sanitary.

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. 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: 04/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2026
LIC9099 (FAS) - (06/04)
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