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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 552701305
Report Date: 07/29/2026
Date Signed: 07/29/2026 10:06:39 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2026 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20260401103909
FACILITY NAME:SKYLINE PLACE SENIOR LIVINGFACILITY NUMBER:
552701305
ADMINISTRATOR:PAIS, VALERIEFACILITY TYPE:
740
ADDRESS:12877 SYLVA LANETELEPHONE:
(209) 288-4630
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:135CENSUS: 110DATE:
07/29/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Executive Director Valerie Pais TIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Illegal eviction

Facility failed to report neglect by POA
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to this facility to deliver complaint findings. LPA Lund met with Executive Director Valerie Pais and explained the purpose of the visit.

Illegal eviction- LPA Lund reviewed facility paperwork and interviewed staff. Based on reviewed facility paperwork and interview with staff. LPA Lund reviewed the Unlawful Detainer that Resident (R1) was given. The facility did the proper Unlawful Detainer and the Tuolumne County Sheriff’s Department removed R1 on 4/4/2026. R1’s Power of Attorney was not able to make it and the Tuolumne County Sheriff’s Department took R1 to the Emergency room until R1 was moved to a long-term facility.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
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 27-AS-20260401103909
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SKYLINE PLACE SENIOR LIVING
FACILITY NUMBER: 552701305
VISIT DATE: 07/29/2026
NARRATIVE
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Based on reviewed facility paperwork and interview with staff, on the information provided, it was unclear if of an illegal eviction, therefore the allegation was deemed UNSUBSTANTIATED.

Facility failed to report neglect by POA- LPA Lund reviewed facility paperwork and interviewed staff. Based on reviewed facility paperwork and interview with staff. LPA Lund reviewed facility communication with Resident (R1) Power of Attorney (POA). The POA was not able to make it the payments do to R1’s change in finances. The POA tried to make payments and was not able to do so and that was the reason for the Unlawful Detainer.

Based on reviewed facility paperwork and interview with staff., on the information provided, it was unclear if facility failed to report neglect by POA, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2