<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 440708773
Report Date: 01/22/2025
Date Signed: 04/23/2025 01:19:55 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
06/16/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220616104145
FACILITY NAME:DOMINICAN OAKSFACILITY NUMBER:
440708773
ADMINISTRATOR:KATHERINE WILLFACILITY TYPE:
740
ADDRESS:3400 PAUL SWEET ROADTELEPHONE:
(831) 462-6257
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY:142CENSUS: 50DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Amy SaulnierTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has an outbreak of COVID-19
Facility is not following the proper protocol for COVID-19
Insufficient staffing to meet resident's needs
Facility did not meet reporting requirements
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 ***This Is an amended report ***

On 1/22/2025 Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit at the facility. LPA met with facility Administrator Amy Saulnier (ADM) and explained the purpose of the visit.

For the allegations of facility has an outbreak of COVID-19 and facility did not meet reporting requirements, reporting party (RP) stated that currently there are 4 residents who were tested positive for COVID-19.

According to records review, the facility has sent out memos to residents regarding covid infections. It was also stated in one of the memos that the infections came from outside the facility. Also on these memos, it was stated that the facility is also consulting with Santa Cruz Health Services Agency (SCHSA) regarding recommendations against COVID-19. There was no incident reports submitted to Licensing at this time since as of this complaint was filed the residents who were infected were from the Independent Living side of the facility.

Regarding the allegation of Facility is not following the proper protocol for COVID-19, RP stated that the facility is not following the proper protocol for COVID-19, and they are not taking any precautions for COVID-19. Those residents who were tested positive for COVID-19 are being exposed to other residents and the facility’s administration keeps telling everyone that’s ok.

Based on interview with ADM, during this time, if there were residents who have tested positive, they are isolated in the rooms. The doors have signs and guides for donning and doffing of PPEs and carts where PPEs are stored. There were no common activities, no communal dining. According to S1, there were no cases of covid in the assisted living side of the facility. Although the testing still happens at least 3 times a week. Testing is done on the 3rd, 5th and 7th day. S2 also shared that residents and staff are tested regularly and aside from the signage outside the rooms there are also signs inside the residents’ rooms.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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 2
Control Number 26-AS-20220616104145
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: 01/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA was able to interview residents and additional staff. R1, R2 and R3 all said that during this time there was a lockdown, and they are mostly in their rooms. R1 stated that staff did extra cleaning and they are tested every week. Food is delivered to rooms. R2 shared that the facility handled the outbreak very well. They get updates on cases, the meals are delivered although not the same as when you dine in the dining area. R3 mentioned that they had to stay and the room and not wander around. Food was good, there were a lot of fruits and vegetables.

Based on the records reviewed, the memos released since May 2022 has constant updates regarding testing’s and how many residents and staff have tested positive. In the memo’s provided, there were also constant recommendations regarding masking, social distancing and sanitizing.

Regarding the allegation of insufficient staffing to meet resident's needs, RP stated that due to the lack of staffing the residents have to wait for extended periods to get their food and drinks.

According to the ADM, around this time, the residents have all meals delivered to the doors since there is no communal dining service. If there are staff who got sick, managers and ADM steps in to help facilitate meal delivery to residents in their rooms. Due to melas being delivered, some residents do have to wait. There’s a different starting point for meal delivery each time so that there is balance in the wait time for all residents. Also, if the residents are positive, the staff who delivers would still take time donning PPEs before entering the room. S1 mentioned that meal deliveries have happened since the first lock down. The meals are delivered by two persons for each floor. Meals are in a hot cart with ticket numbers that says what the resident ordered for their meal. When there are call outs on-call staff will be called otherwise it’s the managers who will help cover. S2 also added that sometimes the residents do wonder about the food but understands that it might take while since everyone has the food delivered. S3 shared that there was enough staff to help in the kitchen. They already have a system in place so food was delivered as fast as they can to residents during this time. S4 also shared that staffing is short sometimes but work wise its fine. There are sections assigned to staff but they still talk to each other if anyone needs help or support. S4 also shared that residents do understand that it takes a while for food to arrive. S3 and S4 both mentioned that in cases where help is needed, the dishwashers, maintenance, managers and the chef step in to help so that the food gets delivered to residents on time.

During the resident interviews, R1 mentioned they do have to wait a little bit but it was understandable and you learn to have patience. Staff are always there if R1 needs anything. If it is critical they are at the door right away but if its non-urgent R1 waits a bit. R2 didn’t find any issues with staffing, feels like there was enough staff to help them with their needs. R3 said they get to choose food from the menu provided. There were also enough staff and they are good in responding when R3 pulls the help button.

Based on interviews and records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2