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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202862
Report Date: 09/17/2026
Date Signed: 09/21/2026 10:29:07 AM

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
08/06/2026 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20260806135047
FACILITY NAME:HANSELL VILLAFACILITY NUMBER:
435202862
ADMINISTRATOR:ELIZABETH BAUTISTAFACILITY TYPE:
740
ADDRESS:5343 HANSELL DRIVETELEPHONE:
(408) 362-9195
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: 6DATE:
09/17/2026
UNANNOUNCEDTIME BEGAN:
08:14 AM
MET WITH:Elizabeth BautistaTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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A resident developed unstageable pressure injury on sacral area due to inadequate care and supervision, resulting in hospitalization
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to deliver complaint findings and met with licensee/administrator Elizabeth Bautista (ADM/S1). LPA stated the purpose of the visit.

On 08/06/2026, the Department received a complaint with the above allegation. LPA Partoza conducted a 10-day visit, toured the facility, and gathered information.

On 08/06/2026, the Reporting Party (RP) stated that resident 1 (R1) was transported to the hospital on 08/01/2026 due to vomiting and fluctuating vitals. R1 was admitted for treatment of severe sepsis and pressure injury. RP stated that while R1 was in the emergency department, he/she observed that R1 appeared to be in great pain and could not sit up.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
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 4
Control Number 26-AS-20260806135047
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: HANSELL VILLA
FACILITY NUMBER: 435202862
VISIT DATE: 09/17/2026
NARRATIVE
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On 08/11/2026, the Department interviewed four staff (ADM/S1, S2, S3 and S4) and four residents (R1, R2, R3 and R4). On 08/13/2026, the Department interviewed witness 1 (W1).

Based on interviews conducted on 08/11/2026, S2 and S3 stated that on 07/27/2026, they observed redness approximately the size of a penny on R1’s sacral area and notified ADM/S1. ADM/S1 examined R1’s skin condition without consulting R1’s physician or obtaining direction from a medical professional. ADM/S1 instructed staff to clean the affected area, apply protective ointment, and reposition R1 every two hours. Staff continued to follow ADM/S1s instruction through 07/31/2026. ADM/S1 stated that R1’s physician was not notified from 07/27/2026 through 07/30/2026 because ADM/S1 believed the condition was being maintained and was not worsening.

S2, S3, and S4 stated that they observed changes in R1’s sacral skin condition from 07/27/2026 through 07/31/2026, however, staff did not document the observed changes or progression of the affected area. The changes were not brought to the attention of R1’s physician and responsible person when initially observed. R2, R3, and R4 stated that they were not aware of R1’s pressure injury.

On 07/31/2026, S2, S3, and S4 observed that R1’s sacral condition had progressed to blistering and skin breakdown. ADM/S1 stated he/she contacted R1’s primary care provider’s office and requested that a medical professional come to the facility to examine R1 because R1 was vomiting and vital signs were fluctuating. No medical professional came to the facility on 07/31/2026 and staff continued to follow ADM/S1s instruction for R1 until R1 was transported to the hospital on 08/01/2026 and was admitted for severe sepsis with acute organ dysfunction and unstageable pressure injury. R1 was discharged back to the facility with hospice services on 08/07/2026 and required total assistance with repositioning, wound care, repositioning every two hours, and documentation of care.

Based on interviews and records reviewed, staff observed changes in R1’s physical condition as R1’s pressure injury progressed between 07/27/2026 through 07/31/2026. The facility did not ensure that the changes were documented, timely, brought to the attention of R1’s physician and responsible person, or that appropriate assistance was provided. ADM/S1 directed staff to provide skin care without obtaining direction from a medical professional. On 08/01/2026, R1 was hospitalized and treated for severe sepsis with acute organ dysfunction and an unstageable pressure injury.
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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20260806135047
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: HANSELL VILLA
FACILITY NUMBER: 435202862
VISIT DATE: 09/17/2026
NARRATIVE
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Based on observations, interviews conducted and record review(s), the preponderance of evidence standard has been met, therefore the allegation that a resident developed unstageable pressure injury on sacral area due to inadequate care and supervision, resulting in hospitalization. is found to be SUBSTANTIATED per California Code of Regulations (CCR)Title 22, Division 6; Chapter 8, §87466 Observation of the Resident is being cited on the attached LIC 9099D.

    §87466 - The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person...

An immediate civil penalty of $500 is being assessed pursuant to Health and Safety Code section
§1569.49(c)(1). The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation for any of the following serious violations: Any violation that the department determines resulted in the injury or illness of a resident.

The administrator and licensee were informed that an additional civil penalty may be assessed pursuant to Health and Safety Code section §1569.49(f). The Department will notify the licensee/administrator in writing regarding any additional civil penalty assessment.

An exit interview was conducted with licensee/ADM/S1 Elizabeth Bautista, and a copy of the report and appeals rights was provided.

end of report
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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20260806135047
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: HANSELL VILLA
FACILITY NUMBER: 435202862
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2026
Section Cited
CCR
87466
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87466 Observation of the Resident..shall be regularly observed for changes in physical…functioning and provided appropriate assistance.... Changes in physical health shall be documented and brought to the attention of the resident’s physician and responsible person. This requirement is not
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LIC/ADM stated that he/she have created a progress notes and a log for each resident to be monitored for turning and repositioning since 08/11/2026 and assigned on the wall. LIC/ADM/S1 stated that he/she conducted a training with staff. LIC/ADM/S1 stated that the POC will be submitted by 09/18/26.
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met as evidenced by: Based on record reviews and interviews, From 07/27/2026 through 07/31/2026, S1–S4 observed R1’s worsening skin condition but did not document or promptly report the changes to R1’s physician and responsible person. R1 was hospitalized on 08/01/2026 with a
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stage 3 or unstageable pressure injury. This violation resulted in serious bodily injury and posed an immediate risk to R1.
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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.
SUPERVISOR'S NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4