445202706-10-23-2024-26-AS-KHOS-DARSEQ-20241106124908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202706
Report Date: 10/22/2024
Date Signed: 10/23/2024 09:22:09 AM

Unfounded

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
08/02/2021 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20210802092325

FACILITY NAME:	AEGIS ASSISTED LIVING OF APTOS		FACILITY NUMBER:	445202706
ADMINISTRATOR:	GALVAN, GRISELDA		FACILITY TYPE:	740
ADDRESS:	125 HEATHER TERRACE		TELEPHONE:	(831) 684-2700
CITY:	APTOS	STATE: CA	ZIP CODE:	95003
CAPACITY:	100	CENSUS: 80	DATE:	10/22/2024
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Noel Sapitan		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Inadequate staff supervision resulting in medical emergency.

INVESTIGATION FINDINGS:

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On 10/22/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Health Services Director Noel Sapitan and LPA explained the purpose of the visit.

Regarding the allegation of inadequate staff supervision resulting in medical emergency, reporting party (RP) stated that resident (R1) has diabetes and needs to be closely monitored for complications. This is a known condition that the staff is aware about. The diabetes was not adequately monitored by staff and R1’s foot became infected, gangrenous and resulted in R1 losing half of of the foot. RP believes that this was an oversight of the staff and care and supervision was not adequately provided.

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Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20210802092325

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: 10/22/2024

NARRATIVE

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According to the records provided by the facility, based on the assessment done by the facility around April 2021, R1 is independent when it comes to bathing needs, grooming and dressing. Also noted in the progress notes, on 7/19/2021 when it was reported to facility staff that R1 had wounds in his/her toes the, a staff (S1) assessed the wound and advised responsible person (F1) to bring R1 to the emergency room. It was also noted that the R1 was asked when was his/her last shower and the R1 stated that he/she hasn't showered in a while and didn't notice the condition on the toes.

LPA was also able to obtain the blood sugar monitoring log. Part of the log reviewed was from April 04, 2021 to July 7/11/2021. Blood sugar was checked every 7 days, every morning per doctors orders. It is noted on the notes every Sunday. The facility uses the finger stick blood glucose monitoring.

Based on records review, the department has determined that that the allegation was false, could not have happened and/or is without a reasonable basis, therefore the allegation is UNFOUNDED.

Report is reviewed and copy is provided.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC9099 (FAS) - (06/04)

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