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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 445202518
Report Date: 03/08/2025
Date Signed: 03/08/2025 11:51:13 AM

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
06/07/2022 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20220607080558
FACILITY NAME:ALEXANDRIA VICTORIAFACILITY NUMBER:
445202518
ADMINISTRATOR:JOHN GRYSPOS, JR.FACILITY TYPE:
740
ADDRESS:226 MORRISSEY BOULEVARDTELEPHONE:
(831) 429-9137
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:13CENSUS: 9DATE:
03/08/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH: John GraysposTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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9
Resident sustained fracture while in care
Staff did not seek timely medical care for resident in care
Staff did not report resident's incident to appropriate parties
INVESTIGATION FINDINGS:
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13
On at 03/08/25, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with staff Rosie Gryspos and explained the purpose of the visit. Staff called administrator John Grayspos to informed that CCLD was present. Approximately 10 minutes later administrator arrived at the facility. The purpose of this visit is to deliver complaint finding for the allegation above. The current census is 9. A brief interview with conducted with the administrator.

It was alleged that resident sustained a fracture while in care, that staff did not seek timely medical attention for the resident in care, and that staff did not report the incident to the appropriate parties. This investigation involved interviews with facility staff and residents. Based on the interviews, 5 out of 5 staff members denied the allegations and stated that they did not witness the incident. LPA interviewed 2 out of 2 resident who stated that they feel safe and does get medical care when needed.

Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
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 2
Control Number 26-AS-20220607080558
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: ALEXANDRIA VICTORIA
FACILITY NUMBER: 445202518
VISIT DATE: 03/08/2025
NARRATIVE
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During a facility visit on 11/23/24, LPA Lee was unable to obtain relevant records regarding resident (R1). Administrator John Gryspos informed LPA Lee that (R1)'s file had been stored in the facility basement but was destroyed in a flood in 2022; therefore, LPA Lee was unable to interview resident (R1) or (R1)'s responsible party. Due to the lack of documentation and insufficient information, there was no clear indication that the alleged incident occurred.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited. A copy of this report was provided. Exit interview.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2