Evelyn Manor

Allegation investigated: Staff handled resident in an inappropriate manner

On 11/06/25 at 1PM, Licensing Program Analysts (LPAs) D Panlilio and Y Brown conducted an unannounced complaint visit, met with staff (ADM, S1, S2, S3), gathered information on the complaint and delivered investigation finding to ADM. During investigation, LPAs conducted interviews with staff (ADM, S1, S2. S3), clients (C1, C2, C3, C4) and obtained the following documents from administrator – Personnel record, Clients’ roster, admission agreements, physician’s reports, ISP/IPP plans, appraisals, needs & services plans, activities schedules, incident reports. Continued on next page, LIC 9099-C Unsubstantiated Allegation: Staff handled resident in an inappropriate manner Finding: Unsubtantiated During investigation, LPAs interviewed staff (ADM, S1, S2, S3), clients (C1, C2, C3, C4) and reviewed clients’ documents. Staff (ADM, S1, S2, S3) denied mishandling any client while in care. Review of clients (C1, C2, C3, C4) latest ISP/IPP plans dated 09/24/25 showed they are non-verbal and have profound intellectual disabilities. LPAs interviewed Ci1, C2, C3, C4 during visit. However, due to profound intellectual disabilities, LPAs were unable to confirm if staff physically or verbally abused them while in care. Staff stated they do not push or mishandle any client when travelling in or out of their transport vans during outings. On 11/06/25 at around 1:30PM, LPAs observed two male staff safely assist four non-verbal clients out of the transport van into the facility after a community outing. On prior unannounced visits dated 10/01/25 and 11/06/25, LPAs did not observe staff mishandle any clients physically or verbally while exiting from the transport vehicle and returning back to the facility. ADM also stated staff continue to assist and redirect clients daily to help them achieve their care plan goals of being independent in performing their activities of daily living (ADLs) as well as being physically and socially active in the community.. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff handled resident in an inappropriate manner is unsubstantiated. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 15-AS-20251030104340

Type of visit: Prelicensing

On 10/17/2025 , Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a pre-licensing inspection. LPA met with Administrator, Irene Monteclar and explained the purpose of the visit. The facility currently has four (4) residents. The administrator currently holds a certificate (#7033135740) that expires on 6/25/2026. The facility’s fire clearance was approved for four (4) total capacity, all may be non ambulatory. LPA toured facility with Administrator Irene Monteclar including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of five (5) rooms, which (4) are occupied by the residents and one (1) is occupied for an office space for staff. The facility has three (3) bathrooms. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 114.1 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 7/3/2025. LPA reviewed four (4) resident records and four (4) staff records. LPA reviewed a sample of medication. Continued on LIC809-C. Continued from LIC809. The following forms to be updated and submitted to CCLD by 10/24/2025: Liability Insurance (reviewed) LIC 308 Designation of facility's Responsibility LIC 500 Personnel Report No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 17, 2025

Type of visit: Case Management - Other

On 10/17/2025 at 11:30 am, Licensing Program Analyst (LPA), Y. Brown arrived unannounced to conduct a Case Management COMP III visit. LPA met with Administrator, Irene Monteclar and explained the purpose of the visit. LPA presented Component III Power Point during visit and discussed the regulations embodied in the Power Point. LPA observed that the participant gained knowledge about running and maintaining the facility following regulations. A license has not yet been granted to this facility. Licensure is subject to final review and approval by the Centralized Applications Unit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 17, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOFT Capacity: 4 Census (if any clients in care): 4 COMP II Participants: licensee/administrator irene monteclar Interview Method: Telephone interview On 10/3/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 3, 2025