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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202597
Report Date: 09/19/2024
Date Signed: 09/19/2024 04:10:40 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
02/23/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220223151643
FACILITY NAME:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:STEVEN SILACCIFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: 55DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Steven SilacciTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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9
Staff did not safeguard resident's personal items
Staff did not provide resident with activities
Staff did not respond to resident request for assistance in a timely manner
INVESTIGATION FINDINGS:
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5
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On 9/19/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director, Steven Silacci and explained the purpose of today's visit.

Regarding the allegation of staff did not safeguard resident's personal items, Reporting Party (RP) stated that R1s laundry was not individually washed as promised. RP states that other residents wore R1s clothing and were found rummaging in R1s belongings.

LPA interviewed ED and mentioned that laundry is done seprately for each resident. Facility is a memory care facility, we are not able to lock the doors of residents bedrooms. Some residents wander around other residents rooms so we try to redirect them.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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-20220223151643
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
VISIT DATE: 09/19/2024
NARRATIVE
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Regarding the allegation of Staff did not provide resident with activities, RP states that staff left the residents in front of a tv every day and did not provide them with activities.

As ED stated, the facility has an activity coordinator, while we highly encourage residents to participate in the activities provided, it is still the residents right to not join if they don’t want to participate.

LPA also observed residents participating in balloon play during the visit.

Based on records review the facility has different scheduled activities per day like exercises, pet therapies, chair dancing, baking, walking and strolling and more.

Regarding the allegation of Staff did not respond to resident request for assistance in a timely manner, RP states that while visiting she observed residents yelling for assistance and staff never came. The RP notes that residents do not have call buttons in their rooms, so it takes a long time for staff to notice when a resident needs assistance if they notice at all.

ED and WD stated that the staff wont be able to address all the needs at once but they strive to help and assist residents as fast as they can

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

Report is reviewed and copy is provided.

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
02/23/2022 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220223151643

FACILITY NAME:WESTWIND MEMORY CAREFACILITY NUMBER:
445202597
ADMINISTRATOR:STEVEN SILACCIFACILITY TYPE:
740
ADDRESS:160 JEWELL STREETTELEPHONE:
(831) 421-9100
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:59CENSUS: 55DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Steven SilacciTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Questionable Death
Staff mismanaged resident medications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/19/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director, Steven Silacci and explained the purpose of today's visit.

Regarding the allegation of Questionable Death, RP stated that R1 died on 2/8/22 as a result of staff neglect.

Based on records review, according to the progress notes of the facility, on 1/25/2022 8:51 PM Caregiver informed Med Tech that R1 was on the floor. R1 had an unwitnessed- Injury fall at 5pm. Paramedics arrived and assisted R1 and took R1 to the hospital. 1/2712022 10:14 AM Family Member (F1) called and spoke to ED and WD. F1 stated that R1 has been transferred to another hospital. F1 was advised that R1 is able to return back to facility, if needed following hospice admission. Hospital feels R1 will not return to baseline and advised at 97, R1 be admitted to hospice services. 1/31/2022 3:10 PM Received communication from F1and stated that R1 is lucid and able to feed. R1 is currently in a post acute. Although still on hospice, F1 stated R1 Is doing better and has asked to play cards.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20220223151643
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: WESTWIND MEMORY CARE
FACILITY NUMBER: 445202597
VISIT DATE: 09/19/2024
NARRATIVE
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According to ED, R1 hasn’t returned and actually moved out on 2/1/2022, which is also noted in the progress notes.

Regarding the allegation of staff mismanaged resident medications, RP states that staff gave R1 "anti-psychotic" medications to make R1 sleep, but never obtain consent prior to giving the medication.

According to records review, it is stated in R1s service plan that he/she is to be given a Psychotropic Drug like Antidepressants. Also on the records, R1 was only to be given a PRN medication to help sleep but only during bedtime.

Based on interviews and observations, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED.

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

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4