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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 11/09/2024
Date Signed: 11/09/2024 02:36:02 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
01/20/2022 and conducted by Evaluator Pang Lee
COMPLAINT CONTROL NUMBER: 26-AS-20220120113339
FACILITY NAME:SUNSHINE VILLA ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
445202756
ADMINISTRATOR:MCKIE, JAMESFACILITY TYPE:
740
ADDRESS:80 FRONT STREETTELEPHONE:
(831) 459-8400
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:132CENSUS: 107DATE:
11/09/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer Gleitsmann TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not allowing medical professional to treat residents without a 24-hour covid test.
Staff are not allowing visits by family members without a 24-hour covid test.
Staff is not assisting resident with incontinence in a timely manner.
Staff is not feeding the resident his meals.
Staff is not responding to call lights in a timely manner.

INVESTIGATION FINDINGS:
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On 11/09/2024 at 12:30 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Community Relation Assistant Jennifer Gleitsmann and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 107. A brief interview with conducted Jennifer Gleitsman.

Allegations were made that staff are not allowing medical professionals to treat residents without a 24-hour COVID test and staff are not allowing visits by family members without a 24-hour covid test. The investigation included a review of records and interviews with residents and staff. The facility's Mitigation Plan, dated January 14, 2021, was reviewed and was within CDC guidelines. LPA Lee interviewed all 7 residents, none of whom expressed concerns regarding the allegations. Additionally, LPA Lee spoke with all 3 facility staff members, who stated that the facility adheres to CDC guidelines and denied the allegations. Based on the interviews and evidence gathered during the investigation, LPA Lee was unable to corroborate the allegations.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024
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 2
Control Number 26-AS-20220120113339
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: 11/09/2024
NARRATIVE
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Allegation were made that staff are not assisting residents with incontinence care in a timely manner. The investigation included observations, a review of records and interviews with residents and staff. On 10/12/2024, LPA Lee observed a caregiver assisting a resident with incontinence care the resident stated no concerns. LPA Lee reviewed three residents Task Logs, which included incontinence care for the month of August 2024, September 2024 and October 2024 and it was complete. It was also learned that each resident has an individual schedule but are usually checked and changed two to three times per shift. LPA Lee interviewed all 7 residents, none of whom expressed concerns regarding staff assistance for incontinence. Furthermore, resident 1 (R1) had no concerns with staff not assisting R1 with incontinence needs in a timely manner. Additionally, all 3 facility staff members denied the allegations. Based on the interviews and evidence gathered during the investigation, LPA Lee was unable to corroborate the allegation that staff are not assisting residents with incontinence care in a timely manner.

Allegation were made that staff are not providing meals to residents. The investigation included observations, interviews with residents and staff. Based on observation on 10/13/2024, LPAs Lee and Pascua observed a caregiver bring lunch to residents in his/her room. It was also learned that for those residents that can’t go to the dining room for meals the facility staff will make a room service order and deliver the meals to the residents. LPA Lee interviewed all 7 residents, none of whom expressed concerns about staff failing to provide meals. Additionally, all 3 facility staff members denied the allegations. Based on the interviews and evidence gathered during the investigation, LPA Lee was unable to corroborate the allegations that staff are not providing meals to residents.

Allegation were made that staff are not responding to call lights in a timely manner. The investigation included a review of records and interviews with residents and staff. The records showed that response times vary by situation, with an average response ranging from 22 seconds to 57 minutes after the call buttons are pushed. Additionally, the E-Call system log indicated that R1’s calls were responded to within 22 seconds to 30 minutes. LPA Lee interviewed 6 out of 7 residents, none of whom expressed concerns about the timeliness of staff responses to call lights. Residents noted that staff makes a good effort to answer calls promptly. It was also learned that sometimes care staff forget to clear the resident’s call pendant while attending to their needs. LPA Lee interviewed all 3 facility staff members, who denied the allegations. Based on the interviews and evidence gathered during the investigation, LPA Lee was unable to corroborate the allegation that staff are not responding to call lights in a timely manner.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024
LIC9099 (FAS) - (06/04)
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