Marian's Care Home I

Type of visit: Case Management - Other

On 5/7/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to the report of the facility taking care of a resident who has an unspecified wound. LPA Calandra reviewed records and interviewed staff. LPA Calandra collected copies of the following documents: -After care notes from PCP for R1 -R1's latest Physician's report/LIC 602 During the visit, the Administrator called the POA and doctor to ask if they would write letters of support. Those letters will be sent to the Department by 5/15/2026. During record review of R1's file, LPA noticed that there was no Appraisal of Needs and Services. A Type B citation was issued for this deficiency. Deficiencies are cited under California Code of Regulations Title 22. Failure to correct deficiency by the POC due date may result in Civil Penalties. An exit interview was conducted. A copy of this report along with Appeal Rights were provided via email as LPA was experiencing printer issues.the state’s words, verbatim · CDSS document, May 7, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(e)(2) · Plan of correction due date: May 15, 2026

HSC 1569.695(e)(2): Emergency Plans: A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. This requirement is not met as evidenced by: Based on record review, the Licensee did not ensure that an appraisal of resident needs and services plan was created for R1, which is a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 7, 2026

Plan of correction: Licensee will write an Appraisal of Needs and Services and send it to the Department by the POC due date.

Type of visit: Required - 1 Year

On 11/18/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Maritess Dator, Caregiver/House Manager and explained the purpose of the visit. Marian Cua Torres, Administrator/Licensee arrived later during the visit. LPA toured the physical plant, this is a 2-story building with 8 bedrooms(6 for residents and 2 for staff), 2 bathrooms, a living room, dining room, garage, backyard, and Kitchen. All bedrooms had the required furniture and sufficient lighting. The facility's fire alarms and Carbon Monoxide Detectors were observed to be in working order. The facility's fire extinguisher was observed to be fully charged. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's first aid kit had the required items. All sharp objects, soap, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 3 staff files. All staff files were complete, but resident files were missing Appraisal of Needs and Services, Preplacement Appraisals, and Functional Capability Assessments. This facility does not handle cash resources for residents. A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. LPA requested the following documents be sent to the Department by 11/25/2025: LIC 500(Personnel Summary Report), Administrative Organization(LIC 309), Health Screening Reports(All staff), Job Description/Personnel Policies and On the Job Training, Liability Insurance, Administrator Certificate(when received), Dementia Plan of Operation, and Transportation Procedures. During the physical plant tour, LPA observed that R1 had a full bed rail on their bed. Per interview with Licensee, the full bed rail is used at night for R1. While a bed rail that only extends half of the length of the bed is allowed for mobility purposes with a physician's order, a bed rail that extends the entire length of the bed is not allowed as it is considered a type of restraint. A Type A citation was issued for this deficiency. In addition, while reviewing files, LPA noticed that none of the five resident files reviewed had an Appraisal of Needs and Services or preplacement Appraisal. A Type B citation was provided for this deficiency. During file review, LPA observed that the facility did not have documentation of their latest fire/emergency drill which per Title 22 regulations shall be conducted on a quarterly basis. A Type B citation was provided for this deficiency. Deficiencies are cited under the California Code of Regulations(CCR), Title 22. Failure to correct the Deficiencies by the Proof of Correction(POC) due date may result in Civil Penalties. During the visit, Licensee/Administrator expressed interest in signing up for the Department's Technical Support Program. LPA explained the program in detail and provided the website to the Licensee to sign up. An exit interview was conducted. This report was reviewed with facility representatives and a copy along with Appeal Rights provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Required - 1 Year

On 10/18/2024, Licensing Program Analyst (LPA) Tobola and Jian conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver, Bok Eugenio. Administrator, Marian Torres Cua was contacted and arrived later in the visit. The facility currently provides care for 5 residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located in kitchen was found to be charged. Smoke and carbon monoxide detectors located throughout the facility were in working order. There was a sufficient supply of both perishable and nonperishable foods as required, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished constantly throughout the week and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies stored under the kitchen sink were found to be secured. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. During inspection LPA observed resident's (R5) bed to be equipped with two half rails extending the full length of their bed, without physician approval. Licensee contacted R1's physician and will be requesting for an order and exception for R1. There is a single outdoor patio for resident use, all equipped with appropriate shading Continued onto LIC809-C LPA conducted a sample file review for residents and found that all five residents are in need of updated appraisals. Technical Violation issued. Upon a spot check of staff files, LPA found that caregiver staff have current 1st aid and CPR and annual training completed. However, staff S1 & S2 did not have current health screening on file. Technical Violation issued. Lastly, A spot check of medications was conducted and found that all medication counts and records to be in order. Marian Toress Cua's Administrator Certificate, 7001432740 is currently active through 8/25/2025. LPA requested the following documents be sent to CCL by COB 11/1/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penaltiesthe state’s words, verbatim · CDSS document, Oct 18, 2024