Mariah's Garden Home Care 2

We haven’t transcribed this report yet. The complete document is on the state’s site.

Allegation investigated: Licensee is financially abusing resident

Based on information reported by and obtained from complainant, this allegation is substantiated. The preponderance of evidence standard has been met. Copies of 12 cancelled checks paid to Mariah's Garden Home Care were sent to CCLD, totalling $9212.98. The endorsement on the back of the checks shows that the monies were deposited to the Bank of America under the name of licensee. On 6/17/26, licensee Maria Zepeda came to San Bruno regional office with proof that a check for $9212.98 was sent to Benefits Management Corp. and LIFE to pay back the money that was received for the payment of rent and personal and incidental money for former client, who moved from facility when it closed in June 2025. Licensee deposited these funds even though client no longer resided at facility. Deficiency of the California Code of Regulations, Title 22, is issued on a following page. *****This report is signed and issued at Mariah's Garden Home Care in San Bruno********** Substantiatedthe state’s words, verbatim · CDSS document, Aug 5, 2026 · control 14-AS-20260602101447

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Aug 7, 2026

ADDITIONAL PERSONAL RIGHTS ....residents in privately operated RCFEs shall have the personal right to be free from ...financial exploitation... This requirement was not met, as licensee received payment for rent and personal and incidentals for a former client from June 2025 until February 2026. Licensee failed to protect client from financial abuse, which posed an immediate health, safety and personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Aug 5, 2026

Plan of correction: Plan of correction to be submitted to CCLD BY DUE DATE, in which licensee will explain circumstances of the financial mishandling of former client's money, and include how licensee will ensure that clients' finances will be protected in the future.

Type of visit: Case Management - Other

On June 5, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management- facility closure visit. LPA met with Administrator, Ismail Zepeda and explained the purpose of the visit. Licensee notified CCLD of facility closure on 4/18/25. LPA toured the facility. Facility is two floors. Residents resided on the second floor. During the tour, LPA observed the kitchen, living room, dining room, bedrooms and garage. LPA did not observe any residents and did not observe evidence of care and supervision In the home. CCLD will be proceeding with the closure. A forfeiture letter will be sent to licensee and the facility number 415601159 shall be closed. This report is reviewed, and discussed with the Licensee, and a copy is provided. Deficiencies are also delivered during the visit and cited from the California Code of Regulations, Title 22. See LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with administrator and copy of the report and appeals rights are provided.the state’s words, verbatim · CDSS document, Jun 5, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(2) · Plan of correction due date: Jun 6, 2025

87405 Administrator - Qualifications and Duties: (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This regulation is not met as evidenced by: Based on records review, the Licensee/administrator did not follow properly notify CCLD of facility closure and failed to submit a plan including but not limited to; timeframe, transferring of residents which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 5, 2025

Plan of correction: Licensee/administrator shall review regulations Administrator Qualifications 87405(d)(2) and Eviction Procedures 87224(c) and submit acknowledgement to LPA.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.682(a)(2) · Plan of correction due date: Jun 6, 2025

1569.682 Transfer of resident upon forfeiture of license or change in use of facility; duties of licensee; closure plan; duty of department upon licensee’s failure to comply; civil penalties: (a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility... as a result of the forfeiture of a license, as described in subdivision (a), (b), or (f) of Section 1569.19... pursuant to the department’s regulations, take all reasonable steps to transfer affected residents safely...shall, at a minimum, do all of the following... (2) Provide each resident or the resident's responsible person with a written notice no later than 60 days before the intended eviction. The notice shall include all of the following... This regulation is not met as evidenced by: Based on interviews and records reviews, the facility failed to provide residents a 60- days notice that includes all of the following listed on Health and Safety Code, 1569.682(a)(2); (A)-(F)the state’s words, verbatim · CDSS document, Jun 5, 2025

Plan of correction: Licensee/administrator shall review Health and Safety code 1569.682 and submit acknowledgement to LPA.

Type of visit: POC

On September 17, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Komal Charitra arrived at the facility to conduct a Plan of Correction (POC) visit with regards to the citation given to the facility during an Annual inspection conducted on 09/10/2024. LPAs met with Maria Zepeda, Administrator and explained the purpose of the visit. On 09/10/2024, LPAs Jain And Charitra cited the facility for CA code of regulations section 87307(a)(2)(B) for Personal Accommodations and Services. During the visit conducted on 09/10/2024, LPAs observed 2 beds in the garage used as a sleeping area for a staff member. During today’s visit LPAs didn’t observe any beds in the garage. The garage was observed to be clean and clear of any fire safety hazards. The deficiency has been corrected and cleared. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Sep 17, 2024

Type of visit: Case Management - Deficiencies

On September 17, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Komal Charitra conducted an unannounced case-management visit. On 9/17/2024, LPAs conducted a plan of correction (POC) visit to follow up on an deficiency that was cited during an annual visit on 9/10/2024. LPAs met with staff member (S1), Alejandro Ortiz and explained the purpose of the visit. Administrator, Maria Zepeda joined shortly thereafter. During the visit, LPAs observed S1 to not be fingerprints cleared and/or associated to the facility. Administrator provided fingerprint clearance for S1, however she did not associate them to the facility. Deficiencies are cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with Administrator and a copy of this report and the Appeal Rights is provided.the state’s words, verbatim · CDSS document, Sep 17, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 18, 2024

87355 Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or... Violation of this regulation is not met as evidenced by: Licensee/Administrator failed to associate S1 to the facility prior to working.the state’s words, verbatim · CDSS document, Sep 17, 2024

Plan of correction: Licensee/Administrator shall submit S1's LIC9182 to CCL by 9/17/2024.

Type of visit: Required - 1 Year

On September 10, 2024, Licensing Program Analysts (LPAs) Kiran Jain and Komal Charitra arrived at the facility at 11:45 AM to conduct the Annual 1-year required inspection. LPAs met with Elizabeth Romero and Hani Fadli, caregivers, and explained the purpose of the visit. Maria Zepeda, Licensee/Administrator and Ismail Zepeda, joined shortly thereafter. LPAs toured the physical plant and observed it to be clean and odor free at a comfortable temperature. This is a two-story building with 2 shared resident bedrooms, 2 staff bedroom, 2 full bathrooms, a living room, and a kitchen with dining. No accessible bodies of water or hazards were observed. The fire extinguisher was fully charged and purchased on 09/19/2023. The smoke detector and carbon monoxide detector were fully operational. The attached garage at the first floor was observed to have a washer and dryer for laundry and extra food supply storage. Back half of the garage was observed to be converted into living quarter for the staff members. LPAs observed 2 beds in the living quarter of the garage. All rooms were observed to be clean with required furniture and sufficient lighting. The bathroom was observed to be mold-free and contained grab bars, bar soap, and non-skid mat. Toilet paper rolls and paper towels were not observed in the bathroom. According to the Administrator, residents have behavioral issues. The hot water temperature in the bathroom sink faucet was measured at 133.8°F. Administrator has Hot Water caution signs posted above each sink. Sharp objects, detergents, poisons, and soap were observed to be accessible to persons in care. In the presence of the LPAs, they were locked and are no longer accessible to persons in care. No expired food items were observed. The facility had the required 7 days of non-perishables and 2 days of perishables. LPAs reviewed four resident records and five staff records. All were observed to be complete. Continued to 809-C... The resident’s medications are securely stored in a locked cabinet. Medication administration records (MARs) were reviewed, and no expired medications were observed. The First Aid kit was checked and observed to be completed. The following updated forms are requested to be submitted to CCLD by 09/17/2024: · LIC 500: Personnel Report · Updated LIC 308: Designation of Facility Responsibility · Updated LIC 400: Resident Cash Resources · Updated First Aid Certificate · Liability Insurance · Current Lease Agreement A Type A Violation was provided for the Garage used as a sleeping room for the staff members. The deficiency is cited under the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted. This report was reviewed with Maria Zepeda, Administrator, and a copy of this report along with appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Sep 10, 2024