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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 12/06/2024
Date Signed: 12/06/2024 05:14:03 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
05/22/2024 and conducted by Evaluator Chihhsien Chang
COMPLAINT CONTROL NUMBER: 26-AS-20240522084737
FACILITY NAME:SUNSHINE VILLA ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
445202756
ADMINISTRATOR:MCKIE, JAMESFACILITY TYPE:
740
ADDRESS:80 FRONT STREETTELEPHONE:
(831) 459-8400
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:132CENSUS: 102DATE:
12/06/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Candi BolinTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility staff do not respond to the email of complaints from family members of residents.
Facility does not have directors of health service and resident service to manage and supervise caregivers to provide care and supervision to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and Met with Administrator (ADM) Candi Bolin.

On 5/22/2024, the Department received a complaint with the above allegations.

On 5/28/2024, the Department conducted an initial investigation visit.

LPA interviewed ADM and 6 staff. LPA toured the facility and interviewed 8 residents.

LPA request roster of clients, LIC500 Personnel summary report.

Continue on LIC9099-C. Page 1 of 3.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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 3
Control Number 26-AS-20240522084737
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: 12/06/2024
NARRATIVE
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Facility staff do not respond to the email of complaints from family members of residents:
The allegation is that the facility Administrator did not respond to the email of complaints from family members of residents.

On 5/28/2024, LPA interviewed Administrator (ADM) Candi Bolin. ADM stated he/she replied to all emails of complaints from family members of residents. ADM stated he/she was the second line to respond to the complaints or requests from the family member of residents before Health Service Director and Resident Care Director left the facility. ADM stated he/she received some enquiries from family members of residents regarding billings or request something after the 2 directors left the facility, and he/she replied to all of them. ADM stated he/she did not receive any complaint regarding care and supervision from family members of residents after the 2 directors left the facility.

LPA interviewed the Facility Nurse (S1). S1 stated before the two directors left the facility, he/she was the second line to receive the complaints from residents or family members. S1 stated he/she did not receive any complain form residents or family members after the two directors left the facility on 5/21/2024.

On 11/17/2024, LPA called two family members (FM1, FM2) of residents and left message. LPA did not any response back.

Based on the interview, there is no evidence to indicate the facility Administrator did not respond to the email of complaint from family members of residents.

Facility does not have directors of health service and resident service to manage and supervise caregivers to provide care and supervision to residents:
On 5/28/2024, LPA interviewed Administrator (ADM). ADM stated the facility Health Service Director and Resident Service Director left the facility on 5/21/2024, and the two position are still vacancies. ADM stated the facility is seeking for candidates to fill the two positions.

ADM stated he/she and the Facility Nurse S1 share the workloads of the two directors. ADM stated a Med Tech (S2) is assigned as Head of Med Tech to schedule and group Med Techs and Caregivers to provide care and supervision to residents which was part of the two directors' workload.
Continue on LIC9099-C. Page 2 of 3.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20240522084737
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: 12/06/2024
NARRATIVE
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ADM stated a Health Service Specialist (S3) from corporate comes to the facility today to help him/her to operate the facility. ADM stated there is no impact on the facility to provide care and supervision to residents.

LPA interviewed the Facility Nurse (S1). S1 stated he/she, ADM and Head of Med Tech S2 share the workload of the two directors who left the facility on 5/21/2024. S1 stated there is no impact for the leaving of the two directors.

LPA interviewed the Head of Med Tech S2. S2 stated he/she schedules and groups Med Tech and caregivers to provide services to residents, and he/she also conducts the work of Med Tech when he/she is available. S2 stated he/she can handle it and there is no impact for the leaving of the two directors.

LPA interviewed the Health Service Specialist from Corporate (S3). S3 stated he/she comes to help the facility. S3 stated his/her job is to make sure residents receive good care and to audit the facility.

LPA interviewed another 3 staff. 3 Out of 3 staff stated there is no impact for the leaving of the 2 directors.

LPA interviewed 8 residents. 8 Out of 8 residents stated they do not have complaint against the facility. 2 Out 8 residents stated they there is no impact for the leaving of the 2 directors. 6 Out of 8 residents stated they don't know if any of the facility director left.

Based on the interview, no evidence to indicate the facility has impact to provide care and supervision to residents due to 2 directors left the facility.

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.

No citations noted at today’s compliant investigation visit. Exit interview conducted with ADM. A copy of this report was provided to ADM.
Page 3 of 3.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Chihhsien Chang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3