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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445201411
Report Date: 07/10/2024
Date Signed: 08/15/2024 10:04:38 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
06/04/2024 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20240604132035
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: 19DATE:
07/10/2024
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Program Coordinator Carole JarvisTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Program Coordinator Carole Jarvis. (This report is being amended to change the civil penalty amount due to erroneous error.)

On June 4, 2024, the Department received a complaint alleging the facility is operating out of ratio.

On June 13 and July 2, 2024, LPA interviewed staff S1-S6. 4 Out of 6 staff (S1-S4) interviewed stated there have been multiple times when the facility has been out of ratio. 4 Out of 6 staff (S1-S4) stated the day program from Watsonville will contact Aptos Senior Activity center requesting for staff, to meet their ratio, resulting in Aptos Senior Activity Center not meeting the staff to client ratio. S4 stated the facility was short staffed last week; Monday (6/3), Tuesday (6/4), Thursday (6/6). Staff S5 stated the facility is meeting the client to staff ratio, but acknowledged that on June 4, 2024, the facility was short staffed. Staff S6 stated the facility is meeting the client to staff ratio. Page 1 Out of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
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-20240604132035
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: 07/10/2024
NARRATIVE
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Based on a review of an email communication from ADM, dated June 19, 2024, the facility ADM stated that on May 6, 2024, the facility had 20 clients. The email then stated that on 11:30am another client had arrived increasing the client number to 21. Furthermore, the email states that there were 6 staff scheduled, but a staff member went home sick, leaving only 5 staff.

Based on record review, client attendance log and staff daily sign in for the month of May and June 2024, there were 7 days when the facility was not in compliance with the staffing ratio of 1 staff per 4 clients. On May 2, 2024, the facility had 22 clients, and 5 staff past 9:00am. On May 3, 2024, the facility had 21 clients and 4 staff. On May 6, 2024, the facility had 21 clients and 5 staff. On May 9, 2024, the facility had 22 clients and 5 staff. (At 11:30am, an additional staff member started.) On May 16, 2024 the facility had 21 clients and 5 staff. On May 22, 2024, the facility had 21 clients and 5 staff. On June 4, 2024, the facility had 18 clients and 4 staff. (At 11:50am a staff member signed in.)

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.

A civil penalty is being assessed for the amount of $250 for a repeat violation within the same year.

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D.

This report was reviewed with Program Coordinator Carole Jarvis and a copy of the report was provided. Appeal Rights was provided.

END OF REPORT

Page 2 Out of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 26-AS-20240604132035
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: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2024
Section Cited
CCR
82065.5(a)(1)
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82065.5 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 of 1:4, 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: Based on interviews conducted and records reviewed, there have been 7 days when the facility was not in compliance with the staffing ratio of 1 staff per 4 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: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC9099 (FAS) - (06/04)
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