3K Home Care

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management Deficiencies Visit. LPA was greeted and granted entry by Administrative Designee (AD) Teresa Hernandez Celaya at 11am and explained the purpose of the visit. The facility is a single-story five bedroom, two bathroom home with an approved fire clearance of four non-ambulatory and a capacity for six residents in care. The facility has a hospice waiver for four residents. Currently there are three residents in care with one resident receiving hospice services. The facility is currently undergoing a Change of Ownership (CHOW) though the Centralized Applications Bureau (CAB). The Administrator (AD) and Administrator Designee recently had a consultation with the Department's Technical Support Program (TSP) on March 3, 2026. LPA reviewed three of three resident files and three of three staff training and fingerprint records. Three of three residents had bed rails without physician's orders. AD was informed to obtain physician's orders for bed rail orders and that bed rails must be removed since they are considered to be restraints. A Type A deficiency will be cited. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on February 24, 2027. During the visit LPA toured the facility and observed the facility retained a minimum of two days perishable and seven days of non perishable food on hand. Medication storage and sharps and knives were secured. (Continued on LIC 809-C) (Continued from LIC 809) The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Teresa Hernandez Celaya, AD and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, May 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(A) · Plan of correction due date: May 16, 2026

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal ... Postural supports may be used under the following conditions...(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (A) A bed rail (cont'd) that extends from the head half the length of the bed and used only for assistance with... mobility shall be allowed. This requirement was not met as evidenced by: LPA did not find bed rail orders in two of three residents which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 15, 2026

Plan of correction: Administrative Designee obtained bed rail orders for one of three residents. AD removed bed rails and will work with primary care provider (PCP) to assess if bed rails are needed and obtain orders. AD will email LPA documentation by POC due date.

Allegation investigated: Facility did not provide written notice prior to rent increase. Facility falsely claimed resident needed a higher level of care.

On this day Licensing Program Analyst (LPA) Rose Ruppert met with Licensee Maria Manimbo and explained the purpose of the visit was to deliver findings for the above allegations. It was alleged the facility did not provide written notice prior to rent increase and the facility falsely claimed resident needed a higher level of care. The investigation determined as follows: Regarding the allegation that the facility did not provide written notice prior to rent increases, the Department reviewed Resident #1 (R1)’s Admission Agreement, dated November 3, 2023, when R1, a 62-year-old male, was admitted to the facility. R1 paid the rate for a shared bedroom for $3500 per month per Admission Agreement. Three weeks later, on November 24, 2023, an email was sent to R1 with the subject line stating: 30 days’ Notice of Increase or to move out. Per email the rate would increase to $5500 per month due to a higher level of care . No documentation was provided regarding the reassessment. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) Upon review of R1’s file, R1’s admission agreement was altered via handwritten note to show an effective date of December 3, 2023, with a new rate of $5500. On this same page, another handwritten note states on May 7, 2024, the resident transferred to a private room. R1’s admission agreement was again altered via handwritten note to show an effective date of August 3, 2024, with a new rate of $6500. R1 did not receive a written notice by the licensee documenting these changes. There are no signed documents with R1’s signature stating proof of notice was received. Thus, the allegation that the facility did not provide written notice prior to rent increase is Substantiated. Regarding the allegation the facility falsely claimed resident needed a higher level of care, R1’s initial Physician’s Report LIC 602A, dated November 3, 2023, stated R1’s primary diagnosis was Multiple Sclerosis. The report stated R1 had bowel and bladder impairment, motor impairment/paralysis, required continued bed care and has a history of skin condition or breakdown and is bedridden. The facility license, effective October 2, 1997, has a fire clearance for four non-ambulatory with a hospice waiver for two. R1 was initially admitted under the care of hospice services. Per interview with hospice agency, R1 was declining at a rapid rate and was not expected to live as long as R1 has. The Appraisal Needs and Services Plan, dated November 30, 2023, documents the need for a higher level of care in handwritten notes. These notes were handwritten over the initial Appraisal Needs and Services Plan and notates November 15 and November 21, 2023, assessments. It is unclear when the initial Needs and Services Plan was dated and signed due to page four of the document missing. An updated Physician’s Report was not found in R1’s records, indicating no change in R1’s medical condition from the initial needs identified and agreed to by the Licensee at the time R1 was admitted. An email on Friday, November 24, 2023, was provided to R1 stating a rate increase of $2000 due to higher level of care, with no clarification or documentation of the higher level of care required. Thus, the allegation that the facility falsely claimed resident needed a higher level of care is Substantiated. (Continued on LIC 9099-C1) (Continued from LIC 9099-C) Based on records reviewed and interviews conducted the preponderance of evidence standard has been met. Therefore, the allegations that the licensee did not provide written notice prior to rent increase and facility falsely claimed resident needed a higher level of care are Substantiated. The following deficiencies are being cited per California Code of Regulations, Title 22 Division 6. An exit interview was conducted with Maria Manimbo and a copy of this report, Confidential Names List, LIC9099-D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 22-AS-20250805140648

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Jan 30, 2026

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Based on Dept. record review, observations & interviews the Licensee claimed R1 required a higher level of care resulting in an increase of fees from $3500 to $6500. No increase in level of care was documented as required. This poses an immediate risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will submit documentation of R1's change of condition. LE will submit the Appraisal Needs and Services plan prior to R1's admission from November 22 and November 30th and Physician's Reports (LIC 602A) from the Skilled Nursing Facility and Hospice Medical Assessment. LE will ensure all documentation related to investigations are provided to the Department. LE will submit by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.657(a) · Plan of correction due date: Jan 30, 2026

For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident …written notice of the rate increase … The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. This requirement is not met as evidenced by: Based on Dept. record review, observations & interviews the licensee did not provide a written notice of a rate increase detailing additional services to be provided at new level of carethe state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: LE will provide resident notice with descrption and itemizations for level of care needs which require a rate increase. LE will provide LPA with Policy and Procedures regarding rate increases by POC due date. (Cont.'d) or accompanying itemization of charges prior to implementing rent increase for R1. As a result, R1 lacked funds for future rent. This poses an immediate, safety and personal rights risk for persons in care.

Allegation investigated: Facility did not provide written notice prior to rent increase. Facility falsely claimed resident needed a higher level of care.

On this day Licensing Program Analyst (LPA) Rose Ruppert met with Licensee Maria Manimbo and explained the purpose of the visit was to deliver findings for the above allegations. It was alleged the facility did not provide written notice prior to rent increase and the facility falsely claimed resident needed a higher level of care. The investigation determined as follows: Regarding the allegation that the facility did not provide written notice prior to rent increases, the Department reviewed Resident #1 (R1)’s Admission Agreement, dated November 3, 2023, when R1, a 62-year-old male, was admitted to the facility. R1 paid the rate for a shared bedroom for $3500 per month per Admission Agreement. Three weeks later, on November 24, 2023, an email was sent to R1 with the subject line stating: 30 days’ Notice of Increase or to move out. Per email the rate would increase to $5500 per month due to a higher level of care . No documentation was provided regarding the reassessment. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) Upon review of R1’s file, R1’s admission agreement was altered via handwritten note to show an effective date of December 3, 2023, with a new rate of $5500. On this same page, another handwritten note states on May 7, 2024, the resident transferred to a private room. R1’s admission agreement was again altered via handwritten note to show an effective date of August 3, 2024, with a new rate of $6500. R1 did not receive a written notice by the licensee documenting these changes. There are no signed documents with R1’s signature stating proof of notice was received. Thus, the allegation that the facility did not provide written notice prior to rent increase is Substantiated. Regarding the allegation the facility falsely claimed resident needed a higher level of care, R1’s initial Physician’s Report LIC 602A, dated November 3, 2023, stated R1’s primary diagnosis was Multiple Sclerosis. The report stated R1 had bowel and bladder impairment, motor impairment/paralysis, required continued bed care and has a history of skin condition or breakdown and is bedridden. The facility license, effective October 2, 1997, has a fire clearance for four non-ambulatory with a hospice waiver for two. R1 was initially admitted under the care of hospice services. Per interview with hospice agency, R1 was declining at a rapid rate and was not expected to live as long as R1 has. The Appraisal Needs and Services Plan, dated November 30, 2023, documents the need for a higher level of care in handwritten notes. These notes were handwritten over the initial Appraisal Needs and Services Plan and notates November 15 and November 21, 2023, assessments. It is unclear when the initial Needs and Services Plan was dated and signed due to page four of the document missing. An updated Physician’s Report was not found in R1’s records, indicating no change in R1’s medical condition from the initial needs identified and agreed to by the Licensee at the time R1 was admitted. An email on Friday, November 24, 2023, was provided to R1 stating a rate increase of $2000 due to higher level of care, with no clarification or documentation of the higher level of care required. Thus, the allegation that the facility falsely claimed resident needed a higher level of care is Substantiated. (Continued on LIC 9099-C1) (Continued from LIC 9099-C) Based on records reviewed and interviews conducted the preponderance of evidence standard has been met. Therefore, the allegations that the licensee did not provide written notice prior to rent increase and facility falsely claimed resident needed a higher level of care are Substantiated. The following deficiencies are being cited per California Code of Regulations, Title 22 Division 6. An exit interview was conducted with Maria Manimbo and a copy of this report, Confidential Names List, LIC9099-D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 22-AS-20250805140648

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Jan 30, 2026

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Based on Dept. record review, observations & interviews the Licensee claimed R1 required a higher level of care resulting in an increase of fees from $3500 to $6500. No increase in level of care was documented as required. This poses an immediate risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will submit documentation of R1's change of condition. LE will submit the Appraisal Needs and Services plan prior to R1's admission from November 22 and November 30th and Physician's Reports (LIC 602A) from the Skilled Nursing Facility and Hospice Medical Assessment. LE will ensure all documentation related to investigations are provided to the Department. LE will submit by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.657(a) · Plan of correction due date: Jan 30, 2026

For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident …written notice of the rate increase … The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. This requirement is not met as evidenced by: Based on Dept. record review, observations & interviews the licensee did not provide a written notice of a rate increase detailing additional services to be provided at new level of carethe state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: LE will provide resident notice with descrption and itemizations for level of care needs which require a rate increase. LE will provide LPA with Policy and Procedures regarding rate increases by POC due date. (Cont.'d) or accompanying itemization of charges prior to implementing rent increase for R1. As a result, R1 lacked funds for future rent. This poses an immediate, safety and personal rights risk for persons in care.

Type of visit: Case Management - Deficiencies

On this day with Licensing Program Analyst (LPA) Rose Ruppert met with Licensee Maria Manimbo for the purpose of conducting a case management deficiency visit regarding complaint control number 22-AS-20250805140648. During the investigation the following deficiencies were observed: A solvency audit was conducted of the facility finances for the period of July 2024 to June 2025. Per the review, the Licensee’s net profit did not take into account salary and wages in cash to the employee and was therefore determined to be unreliable. Review of the Operating costs determined the licensee did not maintain sufficient cash reserves to cover any unforeseen expense for all twelve months reviewed. The Department reviewed the Balance Sheet (LIC 403) for June 2025. Per review, $83.99 cash was in the financial institution and $11,450 was reported in current assets. The current assets reported were personal valuables, which the Department is unable to verify. The LIC 403 Balance Sheet listed $8,420.19 in liabilities. The balance sheet analysis shows that the working capital available for June 2025 is $83.99 in assets minus $8420.19 in liabilities with a working capital loss of -$8,336.18. Negative working capital indicates a company does not have enough current assets to cover short-term financial obligations. Bank statements were obtained for the period of July 2024 through June 2025. Per review of facility finances, withdrawals exceeded deposits by $6,361.82 in July 2024, and $9,495.47 in June 2025. In addition, it was determined the Licensee did not have a separate business account and has comingled funds with their personal bank funds. In September 2024 and June 2025, there was a negative ending balance, which indicates the facility did not have enough funds to cover its expenses. (Continued on LIC 809-C) (Continued form LIC 809) Six months of utility bills and monthly lease payments were reviewed. While gas statements show the Licensee made payment in March and June 2024, telephone bills show payments were made late for all six months, which resulted in late fees. Electric, water and trash bills were provided every two months. Past due disconnections notices were sent on February, April and June 2024 billing statements. Monthly property lease payments for a twelve-month period were reviewed and the licensee made late payments for ten of the twelve months resulting in the licensee paying $1,450 in late fees. Based on bank statements, utility bills, and facility records reviewed, it was determined the facility does not have sufficient cash reserve to cover operating expenses for one month and the licensee does not have a financial plan that complies with CCR Title 22 Section 87213, Finances. During August 11, 2025 visit to facility, LPA observed Resident 1 (R1) file. Upon review, R1’s Admission Agreement on file was missing last page of R1’s original Admission Agreement containing R1’s signature was missing from file. During the investigation, text messages between R1 and the Licensee were obtained, asking for cash advances. LPA obtained text messages between R1 and the Licensee, asking for cash advances. R1’s Admissions Agreement stated rent is due by the 27th of the month. A screenshot of R1’s cell phone on April 28, 2025, states the Licensee provided the 1st Payment to a loan; taken from the resident. Prior to June 4, 2025, Licensee texted R1 for an advance for the month stating Licensee needed $2,000 for a referral fee for another resident. A screenshot on Wednesday, June 25, 2025, shows R1 wired $4,500 to Licensee’s bank account. Thus, R1 paid $6,500 for rent on June 2025 ($2000 + $4,500) before the 27th of June. Another text screenshot, on July 7, 2025, requests another advance for an undisclosed amount of money. The Licensee currently acts as the facility Administrator and has an administrator certificate which expires on April 26, 2027. Despite this, they did not ensure the facility was in accordance with regulations and established policy, program and budget resulting in insufficient funds maintained and the Licensee borrowing funds from R1. (Continued on LIC 809-C1) (Continued from LIC 809-C) The following deficiencies are being cited per California Code of Regulations, Title 22 Division 6. An exit interview was conducted with Maria Manimbo, Licensee and a copy of this report, LIC9099-D, and appeal rights were provided at the conclusion of the office meeting.the state’s words, verbatim · CDSS document, Jan 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Jan 30, 2026

Additional Personal Rights of Residents in Privately Operated Facilities… residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To be free from…, financial exploitation,… This requirement is not met as evidence by: Based on Dept. records reviewed, observations & interviews, Text messages between Licensee and R1 confirm Licensee required advance payments from R1 on multiple occasions to help fund facility operations. This poses an immediate personal rights risk for persons in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will ensure personal funds and business funds are separate. LE will not ask for advance payment. or Loans. If requested by resident to pay in advance, LE will ensure proper documentation. LE will provide written documentation by signed self certification that LE understands this by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Jan 30, 2026

Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records;…This requirement is not met as evidenced by: Based on Dept. record review, observations and interviews the licensee failed to pay utility bills timely on multiple occasions and comingled Licensee’s personal funds and facility operating funds resulting in a negative working capital. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: LE will work on obtaining more clients to have sufficient funds to operate business. LE will ensure utility and business expenses are paid timely. LE will submit utility and business operating expenses by POC due date for all operating cost bills for January 2026 and will continue to provide proof of bills paid on a quarterly basis.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(d) · Plan of correction due date: Feb 15, 2026

Admission Agreements (d) The licensee shall retain in the resident's file the original signed and dated admission agreement... This requirement is not met as evidenced by: Based on Department record review and interviews the licensee did not retain the original signed and dated Admission Agreement for R1. During records reviewed, the last page of R1’s original Admission Agreement containing R1’s signature was missing from file. This poses a potential personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will retain original admission agreement and ensure all documentation, upon admission, are signed and completed. LE will submit signed, self-certifcation by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(h)(1) · Plan of correction due date: Feb 15, 2026

Administrator – Qualifications and Duties The administrator shall have the responsibility to: Administer the facility in accordance with these regulations and established policy, program and budget. This requirement is not met as evidenced by: Based on Department record review, observations and interviews, the Licensee borrowed money from a resident; co-mingled funds and failed to maintain a budget in accordance with regulations. This poses a potential safety and personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: LE will not comingle, borrow or ask for advances from any resident. LE will submit necessary documentation to designated a new administrator.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: Feb 15, 2026

Accountability of Licensee Governing Body. The licensee..., shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement is not met as evidenced by: Based on Department record review, observations and interviews, the Licensee failed to maintain a budget in accordance with regulations and ensured facility compliance with Title 22. This poses a potential safety and personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will make a bank appointment for a business account. LE will ensure there are sufficient funds for facility operation LE will submit proof of completion by POC due date. LE agreed to receive Technical Support Program (TSP) services.

Type of visit: Case Management - Deficiencies

On this day with Licensing Program Analyst (LPA) Rose Ruppert met with Licensee Maria Manimbo for the purpose of conducting a case management deficiency visit regarding complaint control number 22-AS-20250805140648. During the investigation the following deficiencies were observed: A solvency audit was conducted of the facility finances for the period of July 2024 to June 2025. Per the review, the Licensee’s net profit did not take into account salary and wages in cash to the employee and was therefore determined to be unreliable. Review of the Operating costs determined the licensee did not maintain sufficient cash reserves to cover any unforeseen expense for all twelve months reviewed. The Department reviewed the Balance Sheet (LIC 403) for June 2025. Per review, $83.99 cash was in the financial institution and $11,450 was reported in current assets. The current assets reported were personal valuables, which the Department is unable to verify. The LIC 403 Balance Sheet listed $8,420.19 in liabilities. The balance sheet analysis shows that the working capital available for June 2025 is $83.99 in assets minus $8420.19 in liabilities with a working capital loss of -$8,336.18. Negative working capital indicates a company does not have enough current assets to cover short-term financial obligations. Bank statements were obtained for the period of July 2024 through June 2025. Per review of facility finances, withdrawals exceeded deposits by $6,361.82 in July 2024, and $9,495.47 in June 2025. In addition, it was determined the Licensee did not have a separate business account and has comingled funds with their personal bank funds. In September 2024 and June 2025, there was a negative ending balance, which indicates the facility did not have enough funds to cover its expenses. (Continued on LIC 809-C) (Continued form LIC 809) Six months of utility bills and monthly lease payments were reviewed. While gas statements show the Licensee made payment in March and June 2024, telephone bills show payments were made late for all six months, which resulted in late fees. Electric, water and trash bills were provided every two months. Past due disconnections notices were sent on February, April and June 2024 billing statements. Monthly property lease payments for a twelve-month period were reviewed and the licensee made late payments for ten of the twelve months resulting in the licensee paying $1,450 in late fees. Based on bank statements, utility bills, and facility records reviewed, it was determined the facility does not have sufficient cash reserve to cover operating expenses for one month and the licensee does not have a financial plan that complies with CCR Title 22 Section 87213, Finances. During August 11, 2025 visit to facility, LPA observed Resident 1 (R1) file. Upon review, R1’s Admission Agreement on file was missing last page of R1’s original Admission Agreement containing R1’s signature was missing from file. During the investigation, text messages between R1 and the Licensee were obtained, asking for cash advances. LPA obtained text messages between R1 and the Licensee, asking for cash advances. R1’s Admissions Agreement stated rent is due by the 27th of the month. A screenshot of R1’s cell phone on April 28, 2025, states the Licensee provided the 1st Payment to a loan; taken from the resident. Prior to June 4, 2025, Licensee texted R1 for an advance for the month stating Licensee needed $2,000 for a referral fee for another resident. A screenshot on Wednesday, June 25, 2025, shows R1 wired $4,500 to Licensee’s bank account. Thus, R1 paid $6,500 for rent on June 2025 ($2000 + $4,500) before the 27th of June. Another text screenshot, on July 7, 2025, requests another advance for an undisclosed amount of money. The Licensee currently acts as the facility Administrator and has an administrator certificate which expires on April 26, 2027. Despite this, they did not ensure the facility was in accordance with regulations and established policy, program and budget resulting in insufficient funds maintained and the Licensee borrowing funds from R1. (Continued on LIC 809-C1) (Continued from LIC 809-C) The following deficiencies are being cited per California Code of Regulations, Title 22 Division 6. An exit interview was conducted with Maria Manimbo, Licensee and a copy of this report, LIC9099-D, and appeal rights were provided at the conclusion of the office meeting.the state’s words, verbatim · CDSS document, Jan 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Jan 30, 2026

Additional Personal Rights of Residents in Privately Operated Facilities… residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To be free from…, financial exploitation,… This requirement is not met as evidence by: Based on Dept. records reviewed, observations & interviews, Text messages between Licensee and R1 confirm Licensee required advance payments from R1 on multiple occasions to help fund facility operations. This poses an immediate personal rights risk for persons in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will ensure personal funds and business funds are separate. LE will not ask for advance payment. or Loans. If requested by resident to pay in advance, LE will ensure proper documentation. LE will provide written documentation by signed self certification that LE understands this by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87213 · Plan of correction due date: Jan 30, 2026

Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records;…This requirement is not met as evidenced by: Based on Dept. record review, observations and interviews the licensee failed to pay utility bills timely on multiple occasions and comingled Licensee’s personal funds and facility operating funds resulting in a negative working capital. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: LE will work on obtaining more clients to have sufficient funds to operate business. LE will ensure utility and business expenses are paid timely. LE will submit utility and business operating expenses by POC due date for all operating cost bills for January 2026 and will continue to provide proof of bills paid on a quarterly basis.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(d) · Plan of correction due date: Feb 15, 2026

Admission Agreements (d) The licensee shall retain in the resident's file the original signed and dated admission agreement... This requirement is not met as evidenced by: Based on Department record review and interviews the licensee did not retain the original signed and dated Admission Agreement for R1. During records reviewed, the last page of R1’s original Admission Agreement containing R1’s signature was missing from file. This poses a potential personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will retain original admission agreement and ensure all documentation, upon admission, are signed and completed. LE will submit signed, self-certifcation by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(h)(1) · Plan of correction due date: Feb 15, 2026

Administrator – Qualifications and Duties The administrator shall have the responsibility to: Administer the facility in accordance with these regulations and established policy, program and budget. This requirement is not met as evidenced by: Based on Department record review, observations and interviews, the Licensee borrowed money from a resident; co-mingled funds and failed to maintain a budget in accordance with regulations. This poses a potential safety and personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: LE will not comingle, borrow or ask for advances from any resident. LE will submit necessary documentation to designated a new administrator.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: Feb 15, 2026

Accountability of Licensee Governing Body. The licensee..., shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement is not met as evidenced by: Based on Department record review, observations and interviews, the Licensee failed to maintain a budget in accordance with regulations and ensured facility compliance with Title 22. This poses a potential safety and personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee (LE) will make a bank appointment for a business account. LE will ensure there are sufficient funds for facility operation LE will submit proof of completion by POC due date. LE agreed to receive Technical Support Program (TSP) services.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a case management visit at 2:30pm. LPA was greeted and granted entry by Staff #1. The Administrator was not available at time of visit. LPA conducted a health and safety check of one resident in care. The resident was observed to be clean, clothed and fed and was watching a boxing match on television. Upon interview, resident said they had no complaints and that everything has been fine. LPA interviewed staff regarding care provided. The staff member was making preparations for dinner. LPA observed the kitchen and all appliances were in working order, the gas stove was being used to cook and the refrigerator was filled with more than two days of perishable items. A seven day supply of non-perishable items were also on hand. While touring the facility, all utilities were in working order and include: electricity, water, gas and phone/cable/internet. Staff are being paid in a timely manner. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was not conducted since Administrator/Licensee was not present. A copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

On October 30, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator Maria Manimbo was available to assist with the facility inspection. The facility is licensed for capacity six residents, four (4) non-ambulatory residents with approved hospice waiver for four (4) residents. Currently, there are one (1) Hospice residents present during today’s visit. This is a single story with a detached garage facility. The facility has five bedrooms( three shared resident rooms and two staff rooms) and three bathrooms. At around 7:45AM, LPA conducted a tour of the physical plant accompanied by Administrator Maria Manimbo, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 118.5 degrees F. A comfortable temperature of 74 degrees was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for hygiene products, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient two day perishable and seven day non-perishable food was maintained adequately. CONTINUED ON 809C Facility has supply of emergency food and water. Facility has two fire extinguishers which were mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During the visit, LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone with phone number 657-230-7124 was operational. The last fire drill was conducted on 9/12/2025. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 8/4/2025 – 8/4/2026. A review of two residents (R1-R2) service files and two staff (S1-S2) personnel files revealed to be complete. LPA reviewed Administrator Certification active list and the current administrator's certification is on file for Maria Nelly Manimbo # 7000737740 - Expiration 4/26/2027 No deficiencies during this inspection visit. An exit interview was conducted with Administrator Maria Manimbo, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct a Required - 1 year inspection. LPA was allowed entry into the home by Staff Conrad Manimbo. Administrator Maria Manimbo arrived shortly after. AD's Certificate expires on 04/26/2025. There are 2 Residents and 2 staff present during today's visit. LPA, along with Staff Conrad toured the physical plant. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each Resident comfortably. Bathrooms were checked, toilets/water faucets worked properly and shower was free of mold/mildew. Hot water temperature was within regulatory requirements. Bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen is clean and organized. Perishable and non-perishable food supply was checked and adequately stocked. LPA observed sharps and cleaning supplies are inaccessible to the residents. Smoke detectors and carbon monoxide detector tested operational; Fire extinguisher was fully charged and mounted. No bodies of water were observed outside. Walkways around the home were clear of hazards. Exit gates are unlocked and self-latching. Backyard has a covered patio with patio furniture for outdoor activities and sufficient seating for Residents and visitors. Emergency/Fire Drill are conducted but not documented. LPA observed emergency supplies including food and water. LPA reviewed 2 Resident files and 2 staff file. Resident files contained required documentation such as health assessments and admission agreements. Staff files contained required documentation including fingerprint clearance. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately. Based on the observations made during today’s visit, the following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report, along with Appeals Rights was discussed with the facility Administrator and a copy of this report, and LIC9102TV, were provided via email.the state’s words, verbatim · CDSS document, Oct 11, 2024