Manalo's Board and Care V

Type of visit: Required - 1 Year

On 9/21/2026 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Licensee Josefina Manalo. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas, kitchen area. The indoor and outdoor passageways were free of obstruction. While touring the facility it was observed that the room temperature was at 69 deg F. Hot water was also tested in the bathrooms and the temperature was 112 deg F. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Carbon monoxide monitors are working properly. All fire extinguishers have been checked. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid mats. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Two resident records and two staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA requested the following documents to be emailed: Liability Insurance. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Sep 21, 2026

Type of visit: Required - 1 Year

On 9/10/2025, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Coelestis Chan. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, garage, and kitchen area and backyard. LPA observed a small storage shed at the back of the facility. LPA observed residents having lunch. While touring the facility it was observed that the room temperature was at 69 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply in kitchen and garage refrigerator was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter. Five resident records and five staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. Administrator will send the Liability Insurance to LPA. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Sep 10, 2025

Allegation investigated: Staff did not dispense medication to resident as prescribed.

On 7/31/2025, Licensing Program Analyst (LPA), Grace Donato conducted an announced complaint investigation visit. LPA met Administrator Coelestis Chan, and explained the purpose of today's visit. Regarding the allegation of Staff did not dispense medication to resident as prescribed, RP states on 06/29/2025 and 07/04/2025, he/she observed R1s medication had a half pill left in the bottle. RP states she is unsure what happened to cause half a pill to be left over, but R1s prescription calls for him/her to receive a whole pill. Based on observations, when LPA checked the bottle of pills for R1s medication, it was noted that there was a half pill on it. LPA took photos. Centrally store medication records stated that each pill is equal to 1 doze to be given daily. No instructions for cutting it to half. page 1 of 2 Substantiated ADM added during the interview that morning medications were prepared by the night staff, and the ADM was not made aware of the medication containing a half pill. Based on interviews and observation, the above allegation is determined to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed and copy of the report and appeals rights is provided. page 2 of 2 RP states he/she is unsure if S2 actually hit a resident but R1 once said he/she was beaten in the shower, however RP did not ask R1 who beat him/her. LPA also interviewed staff, S1 denied saying anything about S2 putting up a fist to R1. S1 also shared R1 always has two showers a week and additional ones if needed. R1 is very combative but it takes a lot of patience when they shower R1. S2 mentioned that R1 is combative but listens to him/her most of the time. S2 assists when R1 gets showers because of combative behavior. S2 denied ever hitting R1 or any resident. S3 also added that with R1, it always has to be a 2 person assist for showers due to the behavior. LPA attempted to interview R1 but he/she was not able to give coherent answers to the LPA. Based on records review, the facility has been constantly updating their progress notes regarding R1. There are entries about R1 having combative behaviors during showers, very uncooperative and refusing medications, but staff are still able to provide the needs for activities of daily living for the resident. LPA was also able to obtain police report records. It was stated in the report that there is no merit to the allegations of elder abuse. The facility is neat and clean. The patients at the facility were properly clothed, had no signs of visible injury, and appeared to be adequately fed. Regarding the allegation of staff did not assist residents with obtaining medical care services, RP stated that R1 screams constantly and needs hearing aids. RP states the facility has not made any attempt to have R1s hearing evaluated by a medical professional to determine if he/she needs hearing aids. Based on records review, R1 has been checked by the R1s physician at least twice during the duration of the stay and there were no references about the hearing being an issue. Based on observation, during the LPA visit, when care staff are talking to R1, they are talking in a low voice and asking if R1 needs any help. R1 responds with no issues and can clearly hear what that care staff was telling R1. During the LPAs attempt to interview R1, he/she was responsive even when the LPA was asking questions in a regular voice. page 2 of 3 Regarding the allegation of Licensee did not provide planned activities for residents, RP states the residents just watch television all day because the facility does not provide any activities for them like games or books. During the interviews, S2 stated that they do some exercises in the morning. ADM also stated that they try to provide some activities and try to involve residents but most of them don’t want to participate. S2 mentioned walking the residents out in the morning. S2 also added that 2 of the residents just prefers to chat. Based on records review, facility provided a copy of the activities initiated by care staff everyday. Based on interviews and records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Report is reviewed and copy is provided. page 3 of 3the state’s words, verbatim · CDSS document, Jul 31, 2025 · control 14-AS-20250709160500

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Aug 1, 2025

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This was not met as evidenced by: Based on interviews, records review and observations, R1s medication had a half pill in the bottle where it’s indicated that the dosage is 1 pill daily once a day, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 31, 2025

Plan of correction: Licensee to submit a plan to address the medication issue and to do in-service training for staff regarding medication. Licensee to submit to LPA by POC due date.

Type of visit: Required - 1 Year

On 8/20/24 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Licensee Josefina Manalo. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas, kitchen area. The indoor and outdoor passageways were free of obstruction. LPA observed some residents were in the living room watching tv. While touring the facility it was observed that the room temperature was at 70 deg F. Hot water was also tested in the bathrooms and the temperature was 110 deg F. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. Carbon monoxide monitors are working properly. All fire extinguishers have been checked. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid mats. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Four resident records and four staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Facility accepts hospice residents and are in compliance with the required waiver requirements. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA requested the following documents to be emailed: LIC308, LIC500 & Liability Insurance. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Aug 20, 2024