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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 552701305
Report Date: 02/09/2026
Date Signed: 02/09/2026 10:39:45 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
12/03/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20251203101619
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: 107DATE:
02/09/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Executive Director Valerie PaisTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not prevent inappropriate interactions between residents in care
Resident lost drastic weight while in care due to staff neglect
Staff did not ensure that the resident’s bathing care needs were properly met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to this facility to deliver complaint findings. LPA Lund met with Executive Director Valerie Pais and explained the purpose of the visit. Census 107
Allegation-Staff did not prevent inappropriate interactions between residents in care-
It was alleged that staff did not prevent inappropriate interactions between residents in care. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted it was denied by facility staff that they did not prevent an inappropriate interaction between the residents in care. Facility staff state that the residents are in a consensual relationship and report that both residents are able to express this. In addition, facility staff report that the resident’s family members are aware of the interactions with these residents and report no issues. An interview with the residents were conducted who corroborate these statements. Based on the information gathered, there is not sufficient evidence to prove that the staff did not prevent inappropriate interactions between residents in care.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
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 2
Control Number 27-AS-20251203101619
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: 02/09/2026
NARRATIVE
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Allegation- resident lost drastic weight while in care due to staff neglect-It was alleged that a resident lost drastic weight while in care due to staff neglect. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted it was denied by facility staff that the resident lost drastic weight while in care. It was reported that the resident had maintained weight while on hospice. Further interviews Based on the facilities records, LPA Pascua reviewed the residents weight record in which showed that the resident has not had a drastic weight loss while in care. Based on the information gathered, there is not sufficient evidence to prove that the resident lost drastic weight while in care due to staff neglect.

Allegation- Staff did not ensure that the resident’s bathing care needs were properly met-It was alleged that facility staff did not ensure that the resident’s bathing care needs were properly met. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted, it was denied by facility staff the they did not ensure that the resident’s bathing needs were not met. Facility staff report there have been no issues with ensuring that the resident’s needs are met. In addition, an interview with the resident’s family report that they have no issues with the care needs of the resident. Based on the information gathered, there is not sufficient evidence to prove that the staff did not ensure that the resident’s bathing care needs were properly met.

As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2