<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202706
Report Date: 01/25/2025
Date Signed: 01/27/2025 06:41:03 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/11/2023 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20230511142716
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: 79DATE:
01/25/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jose ColimoteTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator is not on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility.

Staff are not ensuring that food is prepared and served in a safe and healthful manner to residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Administrator is not on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility.

During the investigation LPA observed kitchen in need of additional supervision, lack of activities for scheduled time and residents sitting without supervision in the dining area with toxin unlocked and accessible to residents. LPA was told that the Administrator has given notice and other staff are taking the lead when the Administrator is out.

Allegation: Staff are not ensuring that food is prepared and served in a safe and healthful manner to residents in care. During the inspection of the kitchen LPA observed mold on bread and missing documentation of Consulting services for dietary requirements needs and overall quality of food services.

The Department has investigated the above allegations. Based on interview, record review and observation, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. Deficiencies were cited per California Code of Regulations Title 22. See LIC9099-D.


Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2025
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/11/2023 and conducted by Evaluator Albert Johnson
COMPLAINT CONTROL NUMBER: 26-AS-20230511142716

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: 79DATE:
01/25/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jose ColimoteTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are falsifying documents regarding residents in care.
Staff do not ensure that residents are being fed while in care.
Staff do not ensure that residents' diapering needs are being met while in care.
Staff do not ensure that residents' showering needs are being met while in care.
Resident developed a bladder infection due to staff neglect.
Staff do not respond to residents' requests for assistance in a timely manner.
Staff do not ensure that residents receive medical attention in a timely manner.
Staff do not ensure that there is communication which encourages family/responsible party involvement with the resident in care.
Facility is understaffed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation: Staff are falsifying documents regarding residents in care. Based on records reviewed and observing processes including medication administration, responding to call buttons and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if the records were falsified based on the information available. Unsubstantiated.

Allegation: Staff do not ensure that residents are being fed while in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if staff did not ensure that residents were being fed while in care based on the information available. Unsubstantiated.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20230511142716
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
VISIT DATE: 01/25/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff do not ensure that residents' showering needs are being met while in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if staff did not ensure that residents were being showered while in care based on the information available. Unsubstantiated.

Allegation: Resident developed a bladder infection due to staff neglect. Records reviewed for R1 included discharge summaries and notes at the facility including correspondence with the primary care doctor, the record did not identify lack of supervision or neglect as a cause for treatment of R1's bladder infection. Discharge summaries advise follow-up with the primary care physician and hydration. The department was unable to determine if Resident developed a bladder infection due to staff neglect while in care based on the information available. Unsubstantiated.

Allegation: Staff do not respond to residents' requests for assistance in a timely manner. Based on records reviewed and observation the facility did respond in a reasonable amount of time during the department unannounced visits. The facility provided residents with assistance that varied also noted is the activated call button announce the call. The department was unable to determine if Staff did not respond to residents' requests for assistance in a timely manner based on the information available. Unsubstantiated.

Allegation: Staff do not ensure that residents receive medical attention in a timely manner. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if Staff did not ensure that residents receive medical attention in a timely manner while in care based on the information available. Unsubstantiated.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 26-AS-20230511142716
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
VISIT DATE: 01/25/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff do not ensure that there is communication which encourages family/responsible party involvement with the resident in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The facility provides information in three place including a current life enrichment activities sheet. The department was unable to determine if at the time of the complaint that Staff did not ensure that there was communication which encourages family/responsible party involvement with the resident in care based on the information available. Unsubstantiated.

Allegation: Facility is understaffed, Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if at the time of the complaint the facility was under staffed. Unsubstantiated.

Based on this investigation the allegations may have happened or are valid, however, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore these allegations are unsubstantiated.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20230511142716
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: AEGIS ASSISTED LIVING OF APTOS
FACILITY NUMBER: 445202706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2025
Section Cited
CCR
87405(H)(1-8)
1
2
3
4
5
6
7
 The administrator shall have the responsibility to:(1) Administer the facility in accordance with these regulations and established policy, program and budget.
(2) Where applicable, report to the licensee on the operation of the facility, and provide the licensee with necessary interpretations of recognized standards of care and supervision.
(3) Develop an administrative plan and procedures to ensure clear definition of lines of responsibility, equitable workloads, and adequate supervision.
1
2
3
4
5
6
7
The facility has appointed a new Administrator.
8
9
10
11
12
13
14
This requirement was not met as evidenced by the kitchen in need of additional supervision, lack of activities for scheduled time and residents sitting without supervision in the dining area with toxin unlocked and accessible to residents. LPA was told that the Administrator has given notice and other staff are taking the lead when the Administrator is out.
8
9
10
11
12
13
14
Type B
02/14/2025
Section Cited
CCR
87555(b)(8)
1
2
3
4
5
6
7
(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. The licensee did not provide food of good quality. During the inspection of the kitchen LPA observed mold on bread and missing documentation of Consulting services for dietary requirements needs and overall quality of food services.
1
2
3
4
5
6
7
Licensee to check all the non-perishable food in the pantry and dispose expired food immediately.
Consulting services will be included in the plan of correction and sent to the department by 2/14/2025
8
9
10
11
12
13
14
This poses a potential health risk to residents in care. Staff disposed the expired non-perishable food immediately upon discovery.

8
9
10
11
12
13
14
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: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5