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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 390313073
Report Date: 07/23/2025
Date Signed: 07/23/2025 02:54:41 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
07/15/2025 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20250715112301
FACILITY NAME:GAPASIN MANOR #3FACILITY NUMBER:
390313073
ADMINISTRATOR:GAPASIN, VIOLETA T.FACILITY TYPE:
735
ADDRESS:2211 SANDRINGHAM WAYTELEPHONE:
(209) 951-1124
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee is not ensuring that accurate records of residents' accounts of cash resources, personal property, and valuables are maintained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst LPA Noel Wolf Petersen, arrived at 12:45 on 7/23/25 unannounced to the facility, to investigate a complaint, the LPA met with facility administrator/licensee Darrel Gapasin and explainted the purpuse of the visit.

LPA is follow up to a complaint by VMRC, that the P&I logs were found to be accurate and current, they were not consistent with corresponding receipts and reflected frequent loan balances. The LPA looked over The P+I for the six residents, one was found to be out of order, found to be in excess of the amount on the p+I amount. The practices are consistant with the orginal complaint of P+I errors, the LPA gave guideance to the administrator about stewardship practices and responsibilities for the P+I. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is(are) found to be SUBSTANTIATED. California Code of Regulations citation is on the attached LIC 9099D.

A copy of the report was given to the administrator. appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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-20250715112301
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: GAPASIN MANOR #3
FACILITY NUMBER: 390313073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2025
Section Cited
HSC
80026(h)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care...
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Read and be aware of the regulation 80026, signing and returning a copy the the LPA via email. Any policy ammenudms regarding changes to cash handling policies due with the email. both to the LPA by the due date.
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This requirement was not med as evendiced by:

record review and interview of the staff where the the clients P=I wasn not accurately reflecting the cash that was availible.
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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: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2