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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 552701305
Report Date: 10/01/2025
Date Signed: 10/01/2025 02:01:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/30/2025 and conducted by Evaluator Ellen Lindstrom
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250530110109
FACILITY NAME:SKYLINE PLACE SENIOR LIVINGFACILITY NUMBER:
552701305
ADMINISTRATOR:PAIS, VALERIEFACILITY TYPE:
740
ADDRESS:12877 SYLVA LANETELEPHONE:
(209) 288-4630
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:135CENSUS: DATE:
10/01/2025
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Valarie Pais, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff does not provide adequate resident care.
INVESTIGATION FINDINGS:
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On 10/1/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility unannounced to deliver complaint findings. LPA Lindstrom met with Administrator Valarie Pais, explained the purpose of the visit, and conducted an interview.

Allegation: Staff does not provide adequate resident care.
On 6/5/2025, LPA Arielle Pascua conducted the 10-day site visit and interviewed two staff. S1 stated that a resident’s family had recently been concerned about them, but S1 had explained to the family that the resident’s health was declining and that they were developing new behavioral expressions. S1 stated that no other issues had been brought to their attention. S2 stated that there were no complaints with any families regarding care at this time.

On 9/8/2025 and 9/10/2025, LPA Lindstrom interviewed three family members and three staff members.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
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 27-AS-20250530110109
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SKYLINE PLACE SENIOR LIVING
FACILITY NUMBER: 552701305
VISIT DATE: 10/01/2025
NARRATIVE
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F1 stated that staff were meeting their family member’s care needs and that they had no concerns about health and safety. F2 stated that staff was very responsive and checked on their family member frequently. F3 stated that staff was on top of resident care and was always responsive when they brought issues to staff’s attention.

S3 stated that they had not seen any issues with resident care, that staff provided adequate incontinence care, and that staff backed each other up when answering call buttons. S4 stated that when they are short staffed, call button response time may be slower than usual or showers may be delayed, but S4 can still meet all residents’ incontinence needs. S5 stated that incontinence care was sometimes inadequate.

On 9/15/2025, LPA Lindstrom interviewed two residents. R1 stated that all her care needs were met. R2 repeatedly stated that staff does a good job meeting their needs.

Based on interviews and record review, the allegations that staff does not provide adequate resident care is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. As a result of this investigation, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6.

An exit interview was conducted with the Administrator and a copy of this report provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2