Fisher Manor 2

Allegation investigated: Facility does not maintain adequate food supply Staff do not ensure facility is clean and sanitary Facility is in disrepair Licensee does not ensure the facility has emergency food supply on hand

On 08/21/202P6 at 1:30M Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with staff, Hermalinda Vasquez. The investigation consisted of interviews, observation and record review. In regards to the allegation of facility does not maintain adequate food supply: LPA interviewed four (4) residents and two (2) staff. The Four (4) out of four (4) residents interviewed stated that there is always food in the facility. Staff denied the allegation and stated that groceries are ordered and delivered every two (2) weeks or more if needed. LPA observed a stocked pantry and three refrigerator/freezer(s) filled with a variety of meats and other food items. Based on interviews and observation, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff do not ensure facility is clean and sanitary: LPA interviewed two (2) staff and four (4) residents. Staff stated that the facility is cleaned daily and Unsubstantiated there are cleaning supplies readily available. Residents stated that they observe staff cleaning the facility. Based upon interviews, this allegation is UNSUBSTANTIATED. In regards to the allegation of facility is in disrepair: LPA interviewed staff. Staff stated that when there is something that needs to be repaired, management will send a maintenance person to take care of it. Staff denied the allegation. LPA observed bathroom related inventory in boxes in the staff area; waiting to be installed. Based on interview and observation, this allegation is UNSUBSTANTIATED. In regards to the allegation of licensee does not ensure the facility has emergency food supply on hand: LPA interviewed staff. Staff denied the allegation and stated that they have a supply of food in the garage. LPA observed a container filled with additional emergency food in the staff area and additional food in the garage. Based on observation and interview, this allegation is UNSUBSTANTIATED. UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to staff, Hermalinda Vasquez.the state’s words, verbatim · CDSS document, Aug 21, 2026 · control 56-AS-20260617133659

Type of visit: Case Management - Deficiencies

On 06/23/2026 at Licensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to the facility to conduct a Case Management - Deficiencies visit. LPA observed three clients in care. The facility completed a change of ownership and facility change from an Adult Residential Facility (ARF) to a Residential Care Facility for the Elderly (RCFE) on 12/18/2025. LPA interviewed staff and reviewed records. LPA observed that Client 5 (C5) did not have the required documents in their file such as the physician's report with Tuberculosis (Tb) screening, the Pre-appraisal, Admission's Agreement and the resident appraisal. A deficiency will be cited. LPA conducted a telephone interview with Amir Younes and informed him that a letter of exception/waiver must be submitted to Community Care Licensing Division (CCLD) prior tp clients/residents being admitted if their age or needs extend beyond the facility license. The facility did not submit a letter of request. Two (2) out of the five (5) clients in care do not meet the RCFE age requirements. A deficiency will be cited. LPA observed no grab bars (near the toilet or in the shower) in the shared residents' bathroom. A deficiency will be cited. An exit interview was conducted where this report LIC809, LIC809D and Appeal Rights were discussed and copies were provided to staff.the state’s words, verbatim · CDSS document, Jun 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(4) · Plan of correction due date: Jun 24, 2026

87303 (a)(4) Maintenance and Operation (a) The facility shall be clean, safe, sanitary ... (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement is not met as evidenced by: Based on interview and observation, the Licensee/Administrator did not ensure that grab bars were installed/maintained in the residents' shared toilet/shower which poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 23, 2026

Plan of correction: The Licensee/Administrator will obtain a quote for the installation of the grab bars and once installed, send proof using photographs to LPA by Plan of Correction (POC) due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87204(a) · Plan of correction due date: Jun 24, 2026

87204(a) Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license... receive services at any one time. This requirement was not met as evidenced by: Based on interview and observation, the Licensee/Administrator did not ensure that a letter of exception/waiver was submitted to the Department before retaining clients that do not meet the age RCFE requirements, which poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 23, 2026

Plan of correction: The Licensee/Administrator will relocate two of the clients and submit a letter of exception/waiver to the Department by Plan of Correction (POC) due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jun 30, 2026

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on record review, the Licensee/Administrator did not ensure that Client 5 (C5) had the completed required documents in their resident records, which may pose an immediate risk to the health and safetly of residents in care.the state’s words, verbatim · CDSS document, Jun 23, 2026

Plan of correction: The Licensee/Administrator will complete all of the required resdient documents and submit proof to LPA by Plan of Correction (POC) due date.

Type of visit: Prelicensing

On 12/17/2025 at 9:00AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. I met with Administrator, Omar Manasrah . An initial application to operate a Residential Care Facility Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 01/01/2025 for a total capacity of six (6) residents. LPA Small observed the following: Structure: Facility is a house with three (3) resident bedrooms, one (1) staff bedroom and one (1) resident bathroom, living room, dining area and kitchen. There was an detached two car garage in the front of the house. Heating /Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire residence. Bedrooms: All bedrooms are adequately furnished with bed, chair, closet, appropriate linens, adequate lighting. Night lights were observed in the hallway leading to residents' shared bathroom. Bathrooms: The bathroom has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. The water temperature was measured at 112 degrees Fahrenheit. Kitchen: The kitchen has an adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Kitchen: There was sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry: Laundry room with washer and dryer was located near the garage. Laundry detergents and cleaning supplies were observed in a locked cabinet above the washer and dryer. Living /Family Room: There was a living/family room with a TV and adequate seating for all residents. Linens and Hygiene: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outdoors: There is sufficient covered seating area in the backyard. The gate on the right side is the exit and is self-latching. All outdoor pathways were free of obstructions. Facility sketches were observed posted in the kitchen area . LPA observed a fire extinguisher and combination carbon monoxide/smoke detectors, which are working and in good condition. General items: Resident records are stored in a locked cabinet in the office area. First Aid kit with required components are located in laundry area. Medication is kept locked in a cabinet in the office area. LPA observed a facility phone and it was verified to be operational. Emergency water supply and food was observed. An exit interview was conducted, no deficiencies were cited, Component III was completed during this visit and a copy of this report was reviewed and provided to the Administrator, Omar Manasrah. . According to Title 22 California Code of Regulations, the facility has satisfied all of these requirements and is ready for licensure.the state’s words, verbatim · CDSS document, Dec 17, 2025

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: CHOFT Capacity: 6 Census (if any clients in care): 4 Interview Method: Telephone interview On 11/20/2025, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / 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, Nov 20, 2025