Del's Haven

Allegation investigated: Facility staff mismanaged resident's controlled substance Resident's medication records were not maintained Resident's hospice records were not maintained Facility staff did not provide resident's records to their responsible party Facility staff falsified resident's records

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and witness. Regarding the allegations that facility staff mismanaged resident's controlled substance, resident's medication records were not maintained, resident's hospice records were not maintained, facility staff did not provide resident's records to their responsible party and facility staff falsified resident's records, the investigation revealed the following: Resident 1 (R1) was admitted onto Alliance Hospice on 09/30/2025 and passed on 10/12/2025. Resident was prescribed Fentanyl Patch 25 mcg every 72 hours effective 10/07/2025. Facility Medication Administration record shows resident was administered the patch on 10/07/2025 at 1530 and 10/10/2025 at 1530. Facility staff were administering the patch on resident, alternating locations on the body. LPA reviewed Alliance Hospice CONTINUED ON LIC 9099C DATED 11/19/2025 Unfounded records including admission information, emergency guidelines, care plan and admission orders as well as destruction record and visit notes. LPA reviewed texts provided to the family with hospice visit updates and residents status. Witness 1 (W1) is the Durable Power of Attorney (DPOA) and confirms facility has provided any documents that have been requested and have been responsive the entire time R1 has resided at the facility. LPA reviewed the DPOA paperwork dated 10/03/2024 indicating W1 as the healthcare agent. Two out of two staff and W1 confirm the whole family was present at time of death of the resident. Therefore the allegations are deemed UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Exit Interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 19, 2025 · control 22-AS-20251114133858

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Dianna Manalo was notified and arrived later to assist. There are currently four residents in care, none of which are receiving hospice care at this time. One resident was admitted in the hospital on November 9, 2025 and is therefore not present on the premises. Residents are observed relaxing in the facility's common areas or in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with four private and one shared bedrooms. There are two bathrooms used by residents, one of which is en-suite. None of the residents are bedridden at this time. All occupied bedrooms appear clean and sanitary. One resident uses half-length rails for postural support. Adequate physician orders reviewed. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are all equipped with grab bars and slip mats. Hot water temperature measured at 106F and 107F at two separate sinks used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. Two wall-mounted fire extinguishers are present and verified to be charged with up-to-date maintenance tags. Carbon monoxide and smoke detectors were found to be present and operational. Emergency food is present in the pantry and emergency water supplies are stored in the garage. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and facility staff toured the outside of the facility. LPA observed multiple shaded outdoor seating areas with outdoor furniture for resident use around the property in addition to a shed which is used for storage. The identified route of egress is free of clutter and obstructions. There is one self-latching gate on the side of the premises. There is a fenced fountain on the premises. All residents but one clearly show no risk related to the water feature in their assessment. Consultation provided on the updated medical assessment form LIC602A. The facility does not utilize either locked perimeters or delayed egress. LPA reviewed four resident records. Multiple admission agreements reviewed are missing the facility representative signature. Consultation provided. Two residents are using glucose monitoring systems and insulin injections in spite of having physician reports stating they are unable to self-monitor their glucose levels and/or to self-inject insulin. Type B deficiency cited. LPA reviewed resident medication records and prescription orders with no discrepancies observed. LPA reviewed staff records for three staff members during the visit. Proof of current CPR training reviewed. Disaster drills are conducted quarterly. All staff members scheduled are verified to be background cleared and associated to the licensed location. The administrator certificate is current. Based on the observation conducted during the present visit, one type B deficiency is being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Nov 14, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Facility staff are not following resident's dietary needs Facility staff are not adhering to infection control requirements

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit on January 24, 2025 at 1:30pm to deliver the amended complaint report. The findings of the original report have not changed. LPA met with Administrator Dianna Manalo and explained the reason for the visit. The investigation revealed the following. It was alleged that the facility staff are not following resident's dietary needs. LPA interviewed staff. Resident 1 (R1) was at a medical appointment and could not be interviewed. A review of R1's records shows that R1 has been diagnosed with Diabetes and Renal failure. R1 is on dialysis. R1's physician has prescribed a special diet for R1. The Administrator reported that they are following the physician's orders. The Administrator reported they received a list of suggested foods for people on dialysis from the dialysis center where R1 goes. LPA reviewed the facility's menu and it coincides with suggested list of foods for people on dialysis. LPA observed the facility has items in the kitchen such as, spaghetti, carrots, mixed vegetables, Cream of wheat and eggs which were recommended to the facility to provide to R1, from the dialysis center. The Administrator reported that they are following the guidelines from the dialysis center for R1. Unsubstantiated R1 was prescribed a special diet by their physician as noted on their physician’s report. California code of regulation (CCR) 87555(b)(7) states, "Modified diets prescribed by a resident's physician as a medical necessity shall be provided.". The facility is providing the prescribed special diet which also complies with the dietary guidelines recommended by the dialysis center. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, facility staff are not adhering to infection control requirements, revealed the following. It was alleged residents at the facility were ill and the facility failed to implement infection control requirements such as staff wearing masks. LPA interviewed the Administrator, staff and 3 out of 5 residents. 1 resident did not want to be interviewed and the other resident was not present at the facility. 3 out of 5 residents reported they were not ill and are feeling good. Staff reported that all residents cough or sneeze each day but no one reported they were not feeling well and no one is sick. The Administrator reported that none of the residents have been to the doctor recently or diagnosed with any illness. LPA reviewed resident records, there is no recent diagnosis of a contagious disease for any resident. No staff or residents have reported any illness at the facility. At this time because there is no diagnosis of a contagious disease, staff are not required to wear a mask. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the amended report provided. The report was amended to reflect a change in verbiage for the first allegation only.the state’s words, verbatim · CDSS document, Nov 6, 2024 · control 22-AS-20241104100155

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Dianna Manalo and explained the reason for the visit. Dianna Manalo's Administrator's Certificate expires November 15, 2025. LPA and the Administrator toured the facility. The facility is a single story home with 6 bedrooms (1 for staff and 5 for residents), 3 bathrooms, kitchen, dining room, living room with a screened fireplace and a two car garage which is kept locked and used for storage. LPA observed the See Something, Say Something sign. Puzzles and games are stored in the living room under the large screen TV. LPA observed a 2 day perishable and 7 day non-perishable food supply in the kitchen, Knives are kept locked in a ktichen drawer. Cleaning supplies are kept locked under the kitchen sink. The fire extinguisher in the dining room is fully charged. LPA observed all resident rooms had the required furnishings and linens. LPA observed that 3 out of 5 resident had bed rails. All 3 residents had the proper physician's orders for bed rails. LPA observed all 3 bathrooms are clean and operational, hot water measured 107.6 degrees Fahrenheit in all bathrooms. LPA and the Administrator toured the backyard. There is a fountain in the backyard that is fenced. There is a shaded patio with tables and chairs to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. The smoke detectors and carbon monoxide detectors tested operational. LPA observed the first aid kit has all the required elements. LPA reviewed 5 resident records and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Nov 6, 2024