445202756-10-23-2025-26-AS-RMAO-DMRRH8-20251024130153

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 10/07/2025
Date Signed: 10/23/2025 12:28:25 PM

Unfounded

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
02/24/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250224090439

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: 109	DATE:	10/07/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	General Manager Candace Bolin		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident not provided liquids, resulting in dehydration.
Staff does not have training on handling infectious diseases.

INVESTIGATION FINDINGS:

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This is an amended report 10/23/2025 to change the findings from unsubstantiated to unfounded.
Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint visit to deliver the findings on the above allegations. LPA met with Administrator Candace Bolin. LPA stated the purpose of the visit.

On 2/24/2025 the Department received a complaint with the above allegations.

On 2/28/2025 LPAs conducted the initial unannounced investigation visit.

On 2/28/2025, 3/20/2025 and 4/4/2025, LPAs interviewed 7 Staff (S1 to S7), 8 Residents (R2 to R9) and 3 Witnesses (W1 to W3).

Page 1 of 3

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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-20250224090439

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: 10/07/2025

NARRATIVE

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This is an amended report 10/23/2025 to change the findings from unsubstantiated to unfounded.
Resident not provided liquids, resulting in dehydration
It has been alleged by the Reporting Party (RP) that his/her loved one was not provided liquids by staff on 2/14/2025. RP stated at 6PM on 2/14/2025 he/she observed R1 had one half full glass of water next to him/her. RP stated he/she provided the facility with 4 supplemental drinks on 2/14/2025 for R1. RP states on 2/15/2025 he/she observed R1 “to seem like he/she didn’t have any fluids,” and observed 3 full unused supplemental drinks, with one bottle remaining, 1/3 full.

On 2/28/2025, 3/20/2025, and 4/4/2025, LPAs interviewed 7 Staff (S1 to S7). 7 Out of 7 staff stated he/she provides liquids to residents. 7 Out of 7 Staff stated he/she encourages residents to drink liquids when he/she checks on residents.

On 2/28/2025 and 3/20/2025 LPAs interviewed ADM. ADM stated staff check on residents every 2 hours and offer residents and encourages residents to drink water. ADM stated residents are offered liquids during meals and activities. ADM stated residents have access to water in the dining area and in the main lobby of the facility. LPA observed water dispensers in the facility lobby area during the complaint visit on 10/7/2025.

LPA interviewed 8 (R2 to R9) residents. 5 Out of 8 residents stated he/she is provided with liquids by facility staff. R8 and R9 declined to be interviewed. R2 did not provide additional information due to neurocognitive disorder.

LPAs interviewed 3 Witnesses (W1 to W3). W2 stated their loved one is being provided with liquids by the facility and has observed water accessible to residents in the dining and living room areas of the facility. W1 stated his/her loved one was not being provided with liquid but did not provide additional information regarding this incident. W3 stated he/she provides his/her loved one with all liquids, due to a personal preference.

Staff does not have training on handling infectious diseases.
It has been alleged that facility staff do not have training on handling infectious diseases due to an outbreak of COVID in February 2025.

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SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250224090439

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: 10/07/2025

NARRATIVE

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This is an amended report 10/23/2025 to change the findings from unsubstantiated to unfounded.
On 2/28/2025 and 3/20/2025, LPAs interviewed ADM. ADM stated staff have training on infection control.

On 2/28/2025, 3/20/2025, and 4/4/2025, LPAs interviewed 7 Staff (S1 to S7). 7 out of 7 Staff stated he/she received training on infection diseases. 7 Out of 7 staff stated he/she provides liquids to residents if there is a GI illness as part of infection diseases training protocol.

LPA interviewed 8 (R2 to R9) residents. 5 Out of 8 residents stated he/she is provided with liquids by facility staff, part of GI illness infection protocol. R8 and R9 declined to be interviewed. R2 did not provide additional information due to neurocognitive disorder.

LPAs interviewed 3 Witnesses (W1 to W3). 1 out of 3 witnesses state he/she was not informed by the facility about Norovirus in February 2025 and became sick with Norovirus in February 2025 after visiting his/her loved one in the facility. W1 and W2 did not state if he/she was informed about the norovirus by the facility.

LPAs reviewed staff training records dated 2/19/2025 to include the following topics Hand Hygiene, Personal Protective Equipment, GI illness. LPA observed staff signatures on the In-Service and Attendance documentation for the training.

This agency has investigated the complaint alleging Resident not provided liquids, resulting in dehydration, Staff does not have training on handling infectious diseases. 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.

An exit interview was conducted with GM Candace Bolin, and a signed copy of this report was provided.

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END OF REPORT

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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
02/24/2025 and conducted by Evaluator Marcella Tarin

COMPLAINT CONTROL NUMBER: 26-AS-20250224090439

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:	DATE:	10/07/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	General Manager Candace Bolin		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
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5
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9

Licensee did not adhere licensing/other agencys reporting requirements.

INVESTIGATION FINDINGS:

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2
3
4
5
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7
8
9
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11
12
13

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint visit to deliver the findings on the above allegation. LPA met with Administrator Candace Bolin. LPA stated the purpose of the visit.

On 2/24/2025 the Department received a complaint with the above allegation.

On 2/28/2025 LPAs conducted the initial unannounced investigation visit.

On 2/28/2025, 3/20/2025 and 4/4/2025, LPAs interviewed 7 Staff (S1 to S7), 8 Residents (R2 to R9) and 3 Witnesses (W1 to W3).

Page 1 of 2

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

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-20250224090439

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: 10/07/2025

NARRATIVE

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Licensee did not adhere to licensing/other agency’s reporting requirements
It has been alleged that the Licensee did not adhere to licensing/other agency reporting requirements. RP states R1 was sick with Norovirus in February 2025 and was not informed by the facility.

On 2/28/2025 and 3/20/2025, LPAs interviewed ADM. ADM stated he/she did not know if incident reports were sent to the Department regarding residents with norovirus in February 2025.

On 2/28/2025, 3/20/2025 and 4/4/2025, LPAs interviewed 7 Staff (S1 to S7). 6 out 7 staff did not provide additional information regarding reporting requirements. S7 stated he/she did not send incident reports to the Department regarding residents with norovirus in February 2025. S7 states he/she was aware that a couple of families were not notified of Norovirus in February 2025.

On 2/28/2025, 3/20/2025 and 4/4/2025, LPAs interviewed 8 Residents (R2 to R9). 2 Out of 8 Residents state he/she was sick in February 2025. R3, R4, and R7 stated he/she was not sick in February 2025. R8 and R9 declined to be interviewed. R2 did not provide additional information due to neurocognitive disorder.

LPAs interviewed 3 Witnesses (W1 to W3). 1 out of 3 witnesses stated he/she was not informed by the facility about Norovirus in February 2025. W3 states he/she was not notified by the facility and became sick with Norovirus in February 2025 after visiting his/her loved one in the facility. W1 and W2 did not state if he/she was informed about the norovirus by the facility.

Based on LPAs observations, interviews and record reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED per California Code of Regulations, Title 22. A deficiency is being cited on the attached LIC 9099D.

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20250224090439

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: 10/07/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/21/2025 Section Cited CCR 87211(a)(2)	1 2 3 4 5 6 7	87211(a)(2) Reporting Requirements (a) Each licensee shall furnish to the licensing agency...reports......outbreaks, which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours. This was not met as evidenced by:	1 2 3 4 5 6 7	Facility ADM will submit a letter of understanding of the regulation cited. Facility ADM will conduct an in-service training on reporting requirements with management staff and submit proof of in-service training to CCLD by POC due date 10/21/2025.
	8 9 10 11 12 13 14	The facility did not report a norovirus outbreak on February 14th, 2025 to the Department, which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
	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: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025

LIC9099 (FAS) - (06/04)

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