440708773-11-6-2024-26-AS-KHOS-DCJSJY-20250102125555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 440708773
Report Date: 11/06/2024
Date Signed: 11/06/2024 06:01:11 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
09/04/2024 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20240904130824

FACILITY NAME:	DOMINICAN OAKS		FACILITY NUMBER:	440708773
ADMINISTRATOR:	KATHERINE WILL		FACILITY TYPE:	740
ADDRESS:	3400 PAUL SWEET ROAD		TELEPHONE:	(831) 462-6257
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95065
CAPACITY:	142	CENSUS:	DATE:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Amy Saulnier		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff are not providing adequate food service to residents
Facility not following infection controls
Staff are not providing adequate housekeeping services to resident
Facility flooring is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator (ADM) Amy Saulnier. On 09/04/2024, the Department received a complaint with the above allegations. LPA Marrufo conducted an initial complaint investigation on 09/04/2024 and another complaint investigation visit on 10/29/2024.

LPA Marrufo interviewed a total of 17 residents on 09/04/2024, 10/29/2024, and 11/06/2024. 8 out of 17 interviewed residents stated that the staff are not providing food of adequate quality. 9 out of 17 interviewed residents stated that the staff are providing food of adequate quality.

See LIC9099-C for more information. Page 1 of 4.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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 4

Control Number 26-AS-20240904130824

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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14 out of 17 interviewed residents stated the facility staff deliver the food service on time. 1 out of 17 residents stated that the quality of the food service varies and another 1 out of 17 interviewed residents stated that the food service could improve.

LPA Marrufo interviewed a total of 6 staff on 09/04/2024, 10/29/2024, and 11/06/2024. 6 out of 6 interviewed staff stated the staff provide food of adequate quality and provide adequate food service to residents.

During visit on 09/04/2024, LPA Marrufo observed meal preparation in the facility kitchen, meal service in the resident dinning room, and food supplies in the facility refrigerator and food storage areas. LPA Marrufo did not observe any food that appeared to be rotten, spoiled, or of inadequate quality.

LPA Marrufo obtained copies of letters that ADM sent to facility residents on 05/03/2024, 05/06/2024, and 05/16/2024. The letters state that due to COVID outbreaks, communal dinning and activities would be suspended. The letters from 05/03/2024 and 05/06/2024 request that residents stay home if they are experience symptoms. The letter from 05/16/2024 requests that residents who feel ill call the front desk and ask for COVID tests and informs residents that positive residents are required to complete a 10-day isolation pre guidance from the Department of Public Health.

LPA Marrufo interviewed a total of 17 residents on 09/04/2024, 10/29/2024, and 11/06/2024. 15 out of 17 interviewed residents stated that the facility is following infection controls. 1 out of 17 residents stated to have not lived in an assisted living apartment at the facility while there was a COVID outbreak at the facility and another 1 out of 17 residents stated that staff wipe down surfaces but could not remember if staff notify residents of COVID outbreaks.

LPA Marrufo interviewed a total of 6 staff on 09/04/2024, 10/29/2024, and 11/06/2024. On 11/06/2024, LPA Marrufo interviewed staff S1, the facility Infection Control Specialist. 6 out of 6 staff stated that facility staff follow infection control protocols, including notifying residents of COVID outbreaks, wiping down surfaces, and using Personal Protective Equipment (PPE).

Page 2 of 4.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 26-AS-20240904130824

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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S1, the Infection Control Specialist, stated to review and update the Infection Control Plan at least once a year and as needed, ensure staff receive all necessary infection control training, train staff to perform proper hand hygiene, ensure that staff have appropriate personal protective equipment available, and train staff to use personal protective equipment correctly.

During visit, LPA Marrufo observed the facility PPE supply, including gloves, masks, quarantine carts, and cleaning supplies. LPA observed handwashing posters in the bathroom, above the staff time-card machine, and in the medication room. LPA Marrufo observed PPE donning and doffing instructional posters in the medication room and in the quarantine carts.

LPA Marrufo obtained copies of staff infection control training conducted from 06-09/2024.

LPA Marrufo obtained a copy of a letter sent from staff S2, Grounds Manager, to facility residents on 08/22/2024. The letter states that beginning 08/27/2024 and continuing throughout the week, community exterior washing activity would begin and would be conducted by an external contractor. The letter states, “residents will be expected to remove all plants, ornamental figurines or furniture which blocks personnel from easily obtaining access to your patio area. If these items are not moved out of the way, your patio slider doors will not get cleaned.”

A letter printed on green paper that S2 sent to some of the community on 08/27/2024 states that, “If you are receiving this Green memo, your apartment will require contractor escorting services by the Dominican Oaks Maintenance Department to access your patio slider window for cleaning.” The letter does not state any requirements of residents to move any personal belongings away from their glass sliding doors.

LPA Marrufo interviewed a total of 6 staff on 09/04/2024, 10/29/2024, and 11/06/2024. 3 out of 6 interviewed staff stated to have assisted residents by moving their personal belongings away from the sliding glass door to allow for the door to be cleaned. 2 out of 2 interviewed staff stated that residents are notified that personal belongings need to be moved away from the sliding glass door so they can be cleaned.

Page 3 of 4.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20240904130824

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: DOMINICAN OAKS	FACILITY NUMBER: 440708773
	VISIT DATE: 11/06/2024

NARRATIVE

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In addition, LPA Marrufo interviewed S2 on 11/06/2024. S2 stated to have advised contracted window cleaners to not move residents’ personal belongings due to concerns of the contracted window cleaners being liable for any damage to residents’ personal property. S2 stated that if residents need assistance in moving their personal belongings from their glass sliding windows, then they could call the front desk and request for facility staff to move the personal belongings for them.

LPA Marrufo interviewed a total of 17 residents on 09/04/2024, 10/29/2024, and 11/06/2024. 14 out of 17 residents stated to have not had any issues with their personal belongings preventing their glass sliding doors from being cleaned. 1 out of 17 residents stated to not remember, another 1 out of 17 residents stated to have not lived in the assisted living area long enough to have a window cleaning, and another 1 out of 17 residents stated to not know.

LPA Marrufo interviewed a total of 17 residents on 09/04/2024, 10/29/2024, and 11/06/2024. 16 out of 17 interviewed residents stated to have not observed their flooring in disrepair. 1 out of 17 interviewed residents stated to not be able to remember if his/her flooring has been in disrepair.

LPA Marrufo interviewed a total of 6 staff on 09/04/2024, 10/29/2024, and 11/06/2024. 6 out of 6 interviewed staff stated to not have observed a resident’s floor in disrepair.

S2 stated that when transition barriers between the tile floors and the carpets inside resident rooms are damaged, a work order is placed and a contractor repairs or replaces them. LPA Marrufo obtained a copy of a work order for an Assisted Living apartment unit for a re-installed transition strip between the kitchen and hallway. The work order was created on 04/17/2024 and the transition strip was repaired on the same day.

During visit, LPA observed the floors of 13 resident living units. LPA did not observe any signs of damage to the floors, including to the transition barriers between the tile floor and the carpet.

Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Administrator Amy Saulnier and a copy of this report was provided. Page 4 of 4. END REPORT.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4