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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700185
Report Date: 10/21/2025
Date Signed: 10/21/2025 04:13:21 PM

Substantiated


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
10/15/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251015124111
FACILITY NAME:CUPINO HOMEFACILITY NUMBER:
342700185
ADMINISTRATOR:MONICA BUTAYFACILITY TYPE:
735
ADDRESS:8636 LILYPAD LANETELEPHONE:
(916) 509-9450
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 4DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Monica ButayTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staffing ratios are not maintained as specified by the Regional Center
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Monica Butay and later licensee Raul Cupino and explained the purpose of the visit.

When LPA Moleski arrived, all four clients were present (R1-R4). LPA Moleski confirmed that four staff members were present in the facility (S1-S4). LPA Moleski spoke with an Alta California Regional Center representative to confirm minimum staffing requirements. According to ACRC, this facility is required to have five staff members during afternoon hours due to minimum staffing levels of three staff members, plus one-on-one supervision requirements for two clients. LPA Moleski reviewed staffing schedules and observed five staff members were scheduled during today's visit, including Cupino, who was supposed to be providing one-on-one supervision for a client. Cupino was not present when LPA Moleski arrived around 2 p.m. Cupino arrived around 2:50 p.m. LPA Moleski pointed out that the facility was out of ratio to Cupino, and asked for an explanation. Cupino said that he left around 1:30 p.m. to meet with his accountant. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 4
Control Number 27-AS-20251015124111
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: CUPINO HOME
FACILITY NUMBER: 342700185
VISIT DATE: 10/21/2025
NARRATIVE
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The department has determined the following as it relates to the allegation that staffing ratios are not maintained as specified by the Regional Center:

Based on observation, interview, and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Section 85065.5(a)(1). An exit interview was held with Cupino. A copy of this report and appeal rights were left with Cupino.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 27-AS-20251015124111
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: CUPINO HOME
FACILITY NUMBER: 342700185
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/22/2025
Section Cited
CCR
85065.5(a)(1)
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"(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients." This requirement was not met as evidenced by:
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Licensee agrees to send LPA Moleski a written plan of correction by POC due date.
vincent.moleski@dss.ca.gov
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Based on observation, record review, and interview, ACRC staffing ratios were not maintaned for over an hour during this visit, which poses an immediate health, safety, and/or pesonal rights risk.
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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: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4