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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 04/13/2026
Date Signed: 04/13/2026 03:33:15 PM

Substantiated


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
01/13/2026 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20260113082819
FACILITY NAME:SUNSHINE VILLA ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
445202756
ADMINISTRATOR:BOLIN, CANDACEFACILITY TYPE:
740
ADDRESS:80 FRONT STREETTELEPHONE:
(831) 459-8400
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:132CENSUS: 107DATE:
04/13/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:General Manager (GM) Candace BolinTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility staff are not treating residents with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation visit to deliver case findings. LPA met with General Manager (GM) Candace Bolin. LPA stated the purpose of the visit.

On 1/13/2026 the Department received a complaint about the above allegation.

On 1/13/2026 the Department conducted a complaint investigation visit and interviewed 7 Staff (S1 to S7) and 10 Residents (R1 to R10). 7 Out of 7 staff stated he or she treats residents with dignity and respect. S2 stated he/she is aware of a staff having issues with residents. S5 and S6 stated a resident stated that a staff member did not move when he/she was trying to get water from a water dispenser in December 2025.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
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 3
Control Number 26-AS-20260113082819
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: 04/13/2026
NARRATIVE
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On 1/13/2026 the Department interviewed 10 Residents (R1 to R10). 9 out of 10 residents state staff treat him/her with dignity. R1 states that S8 did not move out of the way when he/she was trying to get water from a water dispenser. R1 did not remember the date of this event. R1 states during this incident, he/she asked S8 to move, and the S8 did not respond or move from the dispenser. R1 states he/she was unable to get water from the dispenser. R1 states after this incident he/she informed facility management via email and requested that S8 not come to his/her apartment.

Review of documentation dated 11/23/2025 to 12/23/2025, LPA observed that R1 informed S2 on 11/23/2025 about the incident at the water dispenser with S8. S2 responded on 11/25/2025 and stated management would address the incident with S8.

Review of additional documentation provided by S2 on 3/26/2026, S2 stated that he/she spoke with S8, with S8 reporting that S1 had asked him/her to ‘move with an attitude, that S8 asked S1 to say ‘please’ and that he/she then moved out of the way so the resident could fill his/her water bottle.” The documentation also notes that S8 was provided with education through training and did not receive any disciplinary action for the interaction with R1 on 11/23/2025. S8 was also instructed not to use the 4th floor of the facility for staff breaks or as a quiet area.

On 3/13/2026, 3/19/2026, and 3/27/2026, the Department reached out to S8 for an interview. As of 4/13/2026, S8 has not returned the Department’s request for an interview.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be SUBSTANTIATED. California Code of Regulations (Title 22), are being cited on the attached LIC 9099 D. An exit interview was conducted with GM and a copy of this report was provided. Appeals rights also provided.

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END OF REPORT

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20260113082819
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/14/2026
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

This requirement was not met as evidenced by:
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GM states she will submit a plan of action to ensure staff are treating residents with dignity and respect, to include an all staff training regarding personal rights. POC to be submitted to CCL by POC due date 4/14/2026.
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Based on records reviewed and interviews conducted, S8 stated to S2 that he/she told R1 on 11/23/2025 to say ‘please’ before S8 moved out of the way for S1 to fill a water bottle.” This poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
LIC9099 (FAS) - (06/04)
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