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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445201411
Report Date: 08/04/2023
Date Signed: 08/04/2023 02:03:17 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
07/25/2023 and conducted by Evaluator Simranjit Rai
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20230725145134
FACILITY NAME:APTOS SENIOR ACTIVITY CENTERFACILITY NUMBER:
445201411
ADMINISTRATOR:MAUNA MORRISFACILITY TYPE:
775
ADDRESS:8056 VALENCIA ST.TELEPHONE:
(831) 662-8708
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:42CENSUS: 20DATE:
08/04/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Mauna MorrisTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Simi Rai and Manuel Monter conducted an unannounced complaint investigation regarding the above allegation. LPAs met with facility Administrator (ADM) Mauna Morris.

Upon arrival of the facility, LPAs observed 4 staff members (S1-S4) at the facility. 2 staff members were in the Main Classroom with 20 clients. 1 staff member was observed in the classroom next to the main classroom which is being used as an office. 1 staff member was observed at the front door to escort the residents from transportation van to the main classroom.

LPAs toured the facility, interviewed 4 staff members, and requested the following documentation: staff schedule/ staff sign in log and client daily attendence for the months of June 2023 and July 2023.
Continuation on LIC 9099-C.
Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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 3
Control Number 26-AS-20230725145134
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: APTOS SENIOR ACTIVITY CENTER
FACILITY NUMBER: 445201411
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2023
Section Cited
CCR
82065.5(a)(1)
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Staff-Client Ratio (a)Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met:(1)For Regional Center clients, staffing shall be maintained as specified by the Regional Center.
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Administrator will submit a written plan of how the facility will maintain staff to client ratio and including during breaks (restroom, snack, or diaper change) by POC date. Administrator understood and agreed.
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This requirement is not met as evidenced by: LPAs observed that Staff-Client Ratio (1:4) was not being met in Main Classroom when 4 staff members are present at the facility and observed 20 clients.
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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: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20230725145134
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: APTOS SENIOR ACTIVITY CENTER
FACILITY NUMBER: 445201411
VISIT DATE: 08/04/2023
NARRATIVE
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Page 2 of 2.

Administrator arrived to the facility after LPAs conducted their tour of the facility and staff interviews. LPAs interviewed ADM. Per ADM, the facility clients are part of San Andreas Regional Center and the agreed upon ratio for the facility is 1 staff member to 4 clients. During facility tour, LPAs observed 4 staff members and 20 clients and the current staffing ratio is 1 staff member to 5 clients. ADM confirmed the staffing ratio during today's visit is 1 staff member to 5 clients. Therefore the minimum staffing requirement that is specified by the Regional Center is not met.

Based on record review, LPAs reviewed the resident attendance log and staff daily sign in for June 2023 and July 2023. There were at least 10 days in June and July 2023 where the facility was not in compliance with the staffing ratio of 1 staff per 4 clients.

Based on interviews and observation/inspection of the facility, the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D.
This report was reviewed with Administrator Mauna Morris and a copy of the report was provided. Appeal Rights was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3