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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445202706
Report Date: 03/13/2024
Date Signed: 03/17/2024 07:48:21 PM


Document Has Been Signed on 03/17/2024 07:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 APTOSFACILITY NUMBER:
445202706
ADMINISTRATOR:GALVAN, GRISELDAFACILITY TYPE:
740
ADDRESS:125 HEATHER TERRACETELEPHONE:
(831) 684-2700
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:100CENSUS: 82DATE:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Griselda GalvanTIME COMPLETED:
07:25 PM
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Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required annual inspection and met with facility Administrator (ADM) Griselda Galvan

The facility's census is 82 resident and 82 staff.

LPA toured the facility, including entryway, common room, dining room, kitchen, laundry room, 6 bedrooms, 6 bathrooms, medicine room, and activities room. LPA toured the exterior of the facility and observed all walkways are free from obstruction.

No prohibited items were observed in the resident rooms. All emergency exits are clear from obstruction. The facility has housekeeping schedule for the residents. LPA toured the memory care section and tested the door alarms and found it to be in good working condition. Facility has activities scheduled posted for the whole month. LPA observed residents participating during activity time.

LPA tested the facility water temperature. Water temperature measured between 112 to 116 degree Fahrenheit. LPA observed sufficient supply of food, 2 days of perishable food and 7 days for non-perishable food. Fire extinguisher was last inspected on 10/16/2023. All toxins are kept in a locked room. Knives are locked and is not accessible to residents.

LPA reviewed the facility's fire alarm log. The fire alarms system for the entire building were tested on 3/6/2024 and 3/7/2024 and found to be in good working conditions.

continued to LIC 809C
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SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/13/2024
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LPA interviewed 2 facility staff. LPA reviewed 4 resident files and 4 staff files and found records to be complete and updated.

LPA reviewed the Centrally Stored Medication and Destruction Report for 4 residents and found all records to be updated.

No deficiency was cited during today's visit per CCR Title 22. This report was reviewed with Administrator Griselda Galvan and a copy of the signed report was provided.

End of Report
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SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria PartozaTELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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