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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202706
Report Date: 12/26/2024
Date Signed: 12/26/2024 04:53:55 PM

Unsubstantiated


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
12/18/2024 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20241218160216
FACILITY NAME:AEGIS ASSISTED LIVING OF APTOSFACILITY NUMBER:
445202706
ADMINISTRATOR:GALVAN, GRISELDAFACILITY TYPE:
740
ADDRESS:125 HEATHER TERRACETELEPHONE:
(831) 684-2700
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:100CENSUS: 91DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gloria Escoto, Assisted Living DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility elevator is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Marcella Tarin and David Marrufo arrived unannounced to conduct the initial complaint investigation visit. LPAs met with Assisted Living Director Gloria Escoto.

On 12/18/2024, the Department received a complaint with the above allegation.

The following documents were obtained for this investigation: resident roster, visitor log, maintenance repair invoice, emergency disaster manual, facility emergency disaster plan.

It was alleged that the facility elevator is in disrepair.

LPAs observed the elevator permit with a date of inspection of 8/8/2024, and an expiration date of 8/8/2025.
See 9099-C
Page 1 of 3.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
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 7
Control Number 26-AS-20241218160216
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: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
VISIT DATE: 12/26/2024
NARRATIVE
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The permit was issued by the State of California, Department of Industrial Relations, Division of Occupational Safety & Health.

LPAs reviewed a copy of the Disaster Response Procedures: Elevator Failure guidelines. The guidelines state staff should check to see if there is anyone is the elevator, the general manager should notify the elevator company for repair and initiate communication protocol.

On 12/26/2024, LPAs interviewed Assisted Living Director (ALD). ALD stated the elevator was in disrepair on 12/18/2024. ALD states the elevator was out of service and was repaired that same day. ALD stated the elevator was stuck on the second floor and maintenance was notified. ALD stated the elevator was repaired and working at 2:30PM. ALD states staff and residents were informed of the elevator being in disrepair on 12/18/2024.

LPAs interviewed 5 staff. 2 out of 5 staff state the elevator was in disrepair last week. Staff S2, Maintenance Director, stated the elevator was in disrepair on 12/18/2024 at 9am. S2 states he/she was notified by the facility at 9am on 12/18/2024. S2 states before he/she started repairs he/she made sure no one was inside the elevator. S2 was unable to fix the elevator. S2 states staff, residents and visitors were notified that the elevator was not working. S2 states an elevator repair company was called and the elevator was repaired by 2:30PM that same day. Staff S3 states the elevator was in disrepair on 12/18/2024 and was repaired that same day. 3 out 5 staff stated the elevator has not been in disrepair.

LPAs interviewed 6 residents. 4 out of 6 residents state the elevator has not been in disrepair. 2 residents declined to be interviewed.

LPAs reviewed the elevator repair invoice from the company contracted to repair the elevator. The invoice is dated 12/18/2024, with an incident time of 9:14AM, arrival time of 1:30PM and completion time of 2:30PM. The invoice states the description of the elevator as "elev passenger unit/not resp/stk on 2nd flr". The invoice states the resolution for the elevator as "top floor spirator." The invoice notes the labor hours as 1 hours and 0 minutes for the repair.

See 9099-C
Page 2 of 3.
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
12/18/2024 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20241218160216

FACILITY NAME:AEGIS ASSISTED LIVING OF APTOSFACILITY NUMBER:
445202706
ADMINISTRATOR:GALVAN, GRISELDAFACILITY TYPE:
740
ADDRESS:125 HEATHER TERRACETELEPHONE:
(831) 684-2700
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:100CENSUS: 91DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gloria Escoto, Assisted Living DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility does not have a backup generator for power outages.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Marcella Tarin and David Marrufo arrived unannounced to conduct an initial complaint investigation visit. LPAs met with Assisted Living Director Gloria Escoto.

On 12/18/2024, the Department received a complaint with the above allegation.

The following documents were obtained for this investigation: resident roster, visitor log, maintenance repair invoice, emergency disaster manual, facility emergency disaster plan.

It was alleged that the facility does not have a backup generator for power outages.

See 9099-C
Page 1 of 3.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 26-AS-20241218160216
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: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
VISIT DATE: 12/26/2024
NARRATIVE
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LPAs reviewed the facility's Disaster and Emergency Manual. Under Emergency Generators, the Manual states that if the facility does not have have a generator, the community will identity at least 2 local rental companies to provide an appropriate generator for the community to rent during an emergency or disaster.

LPAs reviewed ALD's file for emergency training. LPAs observed ALD's documentation of Employee Safety Orientation Checklist which includes a training titled "Emergency and Disaster Manual-Location and Contents" which was completed on 1/25/2023.

LPAs reviewed the facility's Emergency and Disaster Plan. Under A.) Provisions for Emergency Power, the facility listed 1 generator rental company.

During interview, ALD stated the facility does not have a backup generator. ALD stated he/she did not call a generator rental company on 12/14/2024 when the facility experienced a power outage from 6:45 AM to 9:45 PM. ALD stated no attempts were made to restore power on 12/14/2024. ALD stated the electric company was notified about the power outage. ALD states staff conducted extra safety check on residents, meals were delivered to residents, and activities were brought into residents rooms. ALD states all residents were given flashlights and lanterns to use in their rooms.

LPAs interviewed 5 staff. 5 out of 5 staff stated the facility has experienced power outages and that the facility does not have a back up generator. 5 staff state when there is a power outage, staff will conduct extra safety checks on residents, assist residents with going upstairs and downstairs, and bring meals to resident rooms.

LPAs interviewed 6 residents. 4 out 6 residents stated the facility had a power outage but did not know if the facility had a backup generator. R2 states the facility had one power outage, but did not know the date of the outage. R2 states the power outage did not impact his/her every day routine. R3 states the facility had a power outage about a week and a half ago,and it lasted the whole day. R3 states the staff brought all his/her meals to the room, and had no concerns during the power outage. R6 states the facility has a power outage, but did not remember the date. R6 states he/she has a flashlight and latern in his/her room that was provided by the facility. R6 states he/she uses oxygen, and has back up battery charged oxygen tanks in the event of a power outage. 2 residents declined to be interviewed.

See LIC9099-C
Page 2 of 3.
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 26-AS-20241218160216
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: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
VISIT DATE: 12/26/2024
NARRATIVE
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The Department has investigated the above allegation. Based on interview, record review and observation, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. A deficiency was cited per California Code of Regulations Title 22. See LIC9099-D. This report was reviewed with Assisted Living Director, Gloria Escoto, and a signed copy of this report and appeal rights were provided.

Page 3 of 3.
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 26-AS-20241218160216
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: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/27/2024
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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Licensee agrees to submit a plan to CCL by POC date 12/27/2024 to ensure that the Emergency Disaster Plan includes the contact information for at least two backup generator rental companies and staff are provided with in-service training on contacting back up generator rental
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Licensee did not ensure that the Emergency Disaster Plan included the contact information for at least two backup generator rental companies and Licensee did not ensure that staff attempted to contact the listed backup generator rental company when the facility was without power from 6:45AM to 9:45PM on 12/14/2024 which poses an immediate safety risk to residents in care.
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companies when there is a power outage at the facility. Once in-service training is completed, Licensee shall provide copies of training records to CCL, includings names, dates, training topics, and names and qualifications of trainers.
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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: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 26-AS-20241218160216
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: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
VISIT DATE: 12/26/2024
NARRATIVE
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Based on the interviews conducted with residents, and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegation is unsubstantiated.

This report was reviewed with Assisted Living Director, Gloria Escoto, and a signed copy of this report was provided.
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7