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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202756
Report Date: 05/14/2026
Date Signed: 05/14/2026 03:07:59 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
08/25/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250825104758
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: 102DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:General Manager (GM) Candace BolinTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not administering medications to resident as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced compliant investigation visit to deliver complaint findings. LPA met with General Manager (GM) Candace Bolin. LPA stated the purpose of the visit.

On 8/25/2025 the Department received a complaint with the above allegation.

On 8/26/2025 the Department interviewed the Reporting Party (RP). RP stated he/she observed a 'little cup, with powder" in a resident's, referred to as R1, room on 8/16/2025. RP states he/she informed facility management about the cup with powder.


Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
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 5
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
08/25/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250825104758

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: 102DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:General Manager (GM) Candace BolinTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not providing adequate care and supervision to resident in care.
Facility does not have enough staff to meet residents needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced compliant investigation visit to deliver complaint findings. LPA met with General Manager (GM) Candace Bolin. LPA stated the purpose of the visit.

On 8/25/2025 the Department received a complaint with the above allegations.

On 9/4/2025 and 10/7/2025 the Department conducted complaint investigation visits, and interviewed General Manager (GM) Candace Bolin, and 6 Staff (S1 to S6). 5 Out of 6 staff state he/she checks on residents every two hours, and will provide assistance to residents when needed. S2 states there has been a time when he/she did not respond to residents due to being 'burnt out.' S2 did not provide addtional information regarding this incident.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20250825104758
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: 05/14/2026
NARRATIVE
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On 5/14/2026 the Department interviewed 5 Residents (R1 to R5). 4 out of 5 residents state he/she does not have any issues or concerns with the care he/she is receiving. R2 states he/she does not require assistance, R2 stated he/she is independent.

Facility does not have enough staff to meet residents needs
On 8/26/2025 the Department interviewed the Reporting Party (RP). RP stated the facility was short staffed, and facility staff had told him/her the facility was short staffed.

On 9/4/2025 and 10/7/2025 the Department conducted complaint investigation visits, and interviewed General Manager (GM) Candace Bolin, and 6 Staff (S1 to S6). GM stated the facility is not short staffed. GM stated the facility uses an outside agency for support on days when there are staff call outs.

On 9/4/2025 and 10/7/2025 the Department interviewed 6 Staff (S1 to S6). 4 Out of 6 staff stated the facility is short staffed. S4 and S5 did not provide information about staffing. S6 stated the facility uses an outside agency to bring in additional staff for support.

On 5/14/2026 the Department interviewed 5 Residents (R1 to R5). 4 out of 5 residents stated he/she does not have any issues or concerns with the care he/she is receiving. R1 states "it's pretty amazing here." R2 stated he/she does not require any assistance, and is independent. R2 stated "staff are great at accommodating."

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with General Manger (GM) Candace Bolin and a copy of this report was provided.

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END OF REPORT

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

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 26-AS-20250825104758
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: 05/14/2026
NARRATIVE
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On 9/4/2025 and 10/7/2025 the Department conducted complaint investigation visits, and interviewed General Manager (GM) Candace Bolin, and 6 Staff (S1 to S6). 3 out of 6 Staff stated he/she is aware or had heard about staff not administering medications to residents as prescribed. S6 stated he/she was informed by RP on 8/16/2025 at approximately 11:44AM regarding a cup with powder in R1's room. S6 stated the powder in the cup was a prescribed powdered medication for R1, that was left in the room by a medtech. S6 stated on 8/16/2025, he/she told the medtech to remove the medication out of R1's room.

Review of R1's Medication Administration Record (MAR) R1 is prescribed one medication in powder form. The MAR notes on 8/16/2025 R1 was administered the powdered medication at 8:00AM by facility staff.

R1's Physician's Report dated 5/16/2023, R1 can store and administer his/her medications.

R1's Care Plan dated 3/25/2025, R1's 'Medication Level of Assistance' states 'Total: Resident is not able to take medications without assistance.' R1's Medication' Additional Information' Supervision states "Resident requires assistance/supervision for medications."

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 Candace Bolin, and a copy of this report and appeal rights were provided.

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END OF REPORT
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20250825104758
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: 05/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.

This was not met as evidenced by:
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Licensee states she will submit a plan of correction regarding how she will ensure staff do not leave prescription medications in residents rooms, to include staff training on centrally storing medications (locked and inaccessible). Licensee to submit POC to CCLD by POC due date of 5/15/2026.
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Based on observation, record review and interview, on 8/16/2025 a powdered prescription medication was left in R1's room by facility staff, which poses an immediate health, safety and 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.
SUPERVISOR'S NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5