Maricar's Manor II

Allegation investigated: Staff are “double diapering” resident

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to deliver final findings of the allegations listed above. Upon arrival LPA met with staff and explained the reason for the visit. LPA contacted Administrator who stated they were unable to be onsite for the visit at this time. On 09/05/2025, LPA conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 09:40 a.m. LPA conducted physical plant tour, interviewed staff, as well as reviewed and obtained copies of pertinent documentation relevant to the investigation. On 10/17/2025, LPA conducted a subsequent complaint visit to continue investigation on the allegations listed above. At approx. 09:30 a.m. LPA conducted physical plant tour, interviewed staff, residents, families / responsible parties as well as reviewed and obtained additional copies of pertinent documentation relevant to the investigation. On 07/28/2026, hospital records were obtained and reviewed. It was reported that “Staff were double diapering R1” as it was alleged that R1 was observed wearing two (2) diapers at the same time. Substantiated Records reviewed revealed that upon R1's admission to the local Hospital on 08/29/2025, hospital staff documented that R1 arrived wearing two (2) diapers with an absorbent pad. The Administrator stated that R1 was experiencing excessive bleeding and frequent bowel movements. Facility staff do not typically place residents in two diapers but did so for R1 due to repeated leakage throughout the day. Interviews with five (5) staff members indicated they do not routinely place residents in (2) diapers at the same time. Interviews with four (4) residents' family members or responsible parties revealed no concerns regarding residents wearing two (2) diapers. The home health nurse, who visited R1 at least twice weekly, reported no concerns related to residents wearing (2) diapers. R1 stated they had worn (2) diapers on multiple occasions but could not identify specific dates or times. LPA was unable to obtain reliable statements from other residents regarding this allegation. Based on the information obtained during the investigation, the Department has sufficient evidence to confirm this allegation occurred. Therefore the allegation "Staff are "double diapering" resident is Substantiated at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D.) Staff was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted with staff, appeal rights discussed and a copy of this report and appeal rights were provided Interviews with five (5) staff members indicated residents were checked before and after meals, at least hourly, before bedtime, upon request, and as needed during the night shift. Interviews with four (4) family members or responsible parties revealed no concerns regarding residents remaining in soiled briefs/diapers for extended periods. The home health nurse, who visited R1 at least twice weekly, also reported no concerns related to residents being left in soiled briefs/diapers for extended periods. LPA’s interview with R1 revealed they were left in soiled diapers on multiple occasions but could not identify specific dates, times, or the reported duration. LPA was unable to obtain reliable statements from other residents regarding this allegation. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff left resident in soiled diapers for an extended period of time” is deemed Unsubstantiated at this time. It was reported that "Staff are not rotating resident every 2 hours resulting in pressure injuries" as it was alleged that staff failed to assist R1 with mobilizing around the facility, resulting in pressure injuries to R1's heels. Records reviewed showed R1 was not admitted to the local hospital with wounds on their heels. The home health nurse, who visited R1 at least twice weekly, stated they did not recall R1 having heel wounds while receiving services at this time. LPA's interview with R1 revealed that R1 stated they had heel wounds while residing at the facility but that the wounds healed before they left. R1 could not recall when the wounds occurred. R1 also stated staff did not assist with walking or mobilizing around the facility or outside but could not identify specific dates or times. R1's records indicated R1 required assistance with transferring, bathing, dressing, and toileting. The records did not indicate a need for any repositioning every two (2) hours. Interviews with five (5) staff members revealed that staff made multiple attempts to encourage R1 to mobilize, and R1 often agreed after repeated encouragement, each staff interviewed do not recall R1 leaving to the hospital with any wounds on their heels. Interviews with four (4) family members or responsible parties revealed no concerns regarding the care provided to residents. LPA was unable to obtain reliable statements from other residents regarding this allegation. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff are not rotating resident every 2 hours resulting in pressure injuries” is deemed Unsubstantiated at this time. Continued from 9099-C It was reported that "Staff took away residents pillows" as It was alleged that staff took R1's pillows. LPA's interview with R1 revealed that upon admission, staff placed pillows under their legs for comfort. It was alleged that after R1's leg cast was removed, staff stopped using the pillows and told R1 they no longer needed them. R1 could not recall specific dates or times and stated they did not ask staff to return the pillows. Interviews with five (5) staff members revealed that they all denied taking pillows from R1 and provided R1 pillows upon request. Staff reported that R1 never complained to them about missing pillows. Interviews with four (4) family members or responsible parties revealed no concerns regarding staff taking residents' personal belongings. LPA was unable to obtain reliable statements from other residents regarding this allegation. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff took away residents pillow” is deemed Unsubstantiated at this time. Exit interview conducted and report provided to staff.the state’s words, verbatim · CDSS document, Aug 13, 2026 · control 29-AS-20250829140205

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Aug 21, 2026

Additional Personal Rights. To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on records review and interviews, the licensee did not comply with the above cited section as R1 was observed wearing 2 diapers, which posed a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Licensee rep agreed to review section cited and provide a letter of understanding and a written plan to ensure future compliance then send to LPA by COB 08/21/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today at 09:30 a.m. Upon arrival, the LPA was greeted by staff who then contacted the Licensee Representative telephonically and informed them of today’s visit. The Licensee Representative, Maricar Lee arrived at approximately 10:20 a.m. Entrance interview conducted. Beginning at 10:25 a.m., the LPA along with the Licensee Representative toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 10:35 a.m. Knives and sharps were observed in a kitchen drawer locked and inaccessible at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed two (2) fire extinguishers to be fully charged with a charge date of 07/28/2025. Fireplace was observed adequately covered at the time of the visit. Required postings were observed throughout the common space. There is a working telephone on premises. Activities were observed in the common areas. At 10:43 a.m., the smoke detector and carbon monoxide were tested and operational at the time of the visit. hazards/obstructions observed inside or out. Report Continued on LIC 809C... Report Continued from LIC 809... Restrooms: There are two (2) restrooms for residents’ use. One (1) bathroom is located inside bedroom #1 and second bathroom was observed by the main hallway. Bathrooms were clean and sanitary and in operating condition with non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:28 a.m., the hot water temperature was measured in both bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit. Bedrooms: There are three (3) bedrooms for resident use and are designated as shared / double occupancy bedrooms. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were observed in a closet by the hallway. Staff bedroom was observed locked and inaccessible at the time of the visit. Garage/Laundry Room: The garage is accessible directly from the main house. Garage was locked at the time of the inspection. Washer and dryer were observed inside the garage. Cleaning supplies and detergents were observed locked and inaccessible at the time of the visit. The LPA observed an adequate amount of emergency food and water. Outdoors: The backyard has a covered patio area with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There is one (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit. Records: Record review began at approximately 10:55 a.m. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, and current needs and services plan. Files were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... Three (3) personnel files were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. Personnel files were complete. Infection Control / Emergency Disaster Planning: The LPA reviewed the facility's infection control plan and emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA observed the emergency disaster plan to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last drill conducted on 03/02/2026. Medications: Medications review began at approximately 01:45 p.m. Medications are centrally stored and kept in a locked cabinet adjacent to the kitchen. Medications are properly documented on the centrally stored medication and destruction record. Medications appear to be administered as prescribed at the time of the visit. No citations issued at this time. Exit interview conducted. Report was reviewed and copy provided.the state’s words, verbatim · CDSS document, Mar 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff and explained the reason for the visit. Licensee Maricar Lee arrived shortly after. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA inspected the kitchen/food service area at approx. 0945 a.m. Knives and sharp objects are stored inaccessible in a drawer to the left of the dishwasher. No cleaning supplies were observed stored in the kitchen area. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. Dining area was observed to be clean and furniture appeared to be in good condition. There is an office area next to the kitchen. LPA observed facility files stored in a shelf and medication properly stored inaccessible in a cabinet next to the dining table. There is an attached garage. LPA observed garage to be inaccessible to residents in care. LPA observed additional fridge and freezer to store extra perishable food. LPA also observed additional non-perishable supplies, canned goods, PPE, extra incontinent supplies, as well as additional furniture and medical equipment for facility use. Laundry area was located in the garage as well along with an office area. At the time of the visit, the common area furniture's were observed to be in good condition. A sufficient supply of clean linen and towels were observed stored in the hallway cabinets. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguishers to be fully charged and last serviced July 30th, 2024. LPA observed four (4) resident bedrooms total. Resident bedrooms were observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bathrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings posted throughout the home. The backyard has a covered outdoor area equipped with furniture including tables and chairs for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. The LPA observed a locked shed with gardening tools and medical equipment inaccessible to residents in care. No bodies of water were noted at the time of the visit. Records review, two (2) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were observed to be in order at this time Medications review, medications are centrally stored in a locked cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit. Infection control, LPA discussed Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE), and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. The LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. Exit interview conducted, discussed and copy of report issued.the state’s words, verbatim · CDSS document, Apr 7, 2025

Allegation investigated: Facility staff punch resident. Resident fell due to lack of supervision.

Licensing Program Analyst (LPA), Erica Mosley conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 08/26/2024 by LPAs E. Mosley and M. Arroyo. On today's visit at 1:43p.m., LPA Mosley met with Licensee Representee,Marica Lee and Administrator Calixto Calixtro. Entrance interview. On 08/26/2024, the Department received a complaint regarding the following allegations, Facility staff punched resident and Resident fell due to lack of supervision.During the initial visit on 08/26/2024, LPA Mosley conducted a plant tour at 10:10 a.m. conducted interviews with the Administrator, four (4) staff, and three (3) residents between 10:01 a.m. and 2:15 p.m., conducted a file review at 10:45 a.m., and obtained copies of pertinent documents relevant to the investigation. LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations. Report Continued on LIC 9099C... Unsubstantiated (2ND PAGE) Report Continued from LIC 9099... On 09/16/2024 telephonic interviews with four (4) family members of residents from 1:35 p.m. to 4:45 p.m. residing at the facility and on 09/16/2024 reviewed relevant documents pertaining to the investigation. On the allegation, Facility staff punched resident, it is the concern of the Reporting Party (RP) that the facility Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) punched Resident #1 (R1) all over the body leaving bruises. R1 reportedly had a bruise on their right shoulder but stated it was unrelated to being punched by staff and was due to a fall. RP reported a full body check was conducted on R1 and R1 had a yellow bruise on the right shoulder only and no bruising on the back. Interviews with residents revealed that facility staff have never been physically aggressive including being punched by staff. Residents stated they have never witnessed or aware of staff being physical including punching any residents including R1. Furthermore, residents denied facility staff being rough or aggressive with them at any time while living at the facility. The LPA was unable to interview R1 as they are no longer living at the facility and their current location is unknown. Interviews with staff including S1, S2, and S3 revealed that staff are unaware of any facility staff punching R1 or ever being physically aggressive towards residents. S1, S2, and S3 deny punching R1. Record review reveal that S1, S2, and S3 have not had any disciplinary action or concerns regarding the quality of care they provide. Interviews with resident families revealed that they visit the facility randomly, unannounced ranging one (1) to four (4) times a week with no concerns with the facility staff including S1, S2, and S3. Families have no concerns with the quality of care the facility provides. They have not witnessed any aggressive behavior including punching by any of the staff. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Facility staff punched resident is deemed unsubstantiated at this time. Report Continued on LIC 9099C 3RD PAGE... ( 3RD PAGE) Report Continued from LIC 9099C 2ND PAGE... On the allegation, Resident fell due to lack of supervision, it is the concern of the Reporting Party (RP) that Resident #1 (R1) fell due to lack of supervision. R1 stated that they have a bruise on their right shoulder due to the fall off of their bed of which staff did not assist R1 with afterwards. RP reported a full body check was conducted on R1 and R1 had a yellow bruise on the right shoulder. Staff interviews revealed that there are always two (2) staff regularly scheduled and record review corroborated that the facility has two (2) staff regularly scheduled. Staff interviewed stated they check on residents frequently and have not had any recent falls that they witnessed or made aware of. Staff stated they are unaware that R1 had any falls while residing at the facility. Resident interviews revealed that two (2) staff are regularly scheduled. Staff are attentive and regularly engaged. Residents have not witnessed or heard of any resident falling recently. Residents did not witness R1 fall and were not made aware of R1 falling. Residents reported no concerns with the supervision the facility provides. Interviews with resident families revealed that they visit the facility randomly, unannounced ranging one (1) to four (4) times a week and the facility always has two (2) staff scheduled. Families were not aware or made aware of any recent falls at the facility. Families state that staff are regularly engaged with the residents and have no concerns with the supervision that is provided at the facility. Although the allegation may have happened or is valid, there is insufficient evidence to support the allegation. Therefore, the allegation of Resident fell due to lack of supervision is deemed unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Nov 18, 2024 · control 29-AS-20240820100505

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management – Incident visit at 1:00 p.m. for the purpose of investigating self-reported incident reports. Upon arrival, LPA met with staff and explained the reason for the visit. During the visit LPA called the Administrator Tina Marie Martinez over the phone who stated that caregiver Calixto Calixtro can sign in their place. On 08/02/2024, the Department received a incident report stating on the evening of 07/31/2024 at approx 10pm, local police department arrived to the home due to Client #1 (C1) stating they were being physically abused by staff. At approx 1pm, LPA conducted physical plant, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. LPA has determine further investigation is needed and will return at a later date to complete the investigation if warranted. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 16, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Zabel Chochian arrived to this property for a pre-licensing inspection. The LPA met with applicant Maricar Lee and Administrator Tina Marie Martnez. This is a change of ownership application from Breen Residential Care - BR Care, INC (#565801904) to Maricar Manor II - Maricar's Manor, Inc (#565850416). The current census is at 3 residents. The fire clearance was granted on 12/15/2023; in which all rooms were cleared for non-ambulatory clients, in which a bedridden person is permitted in Bedroom #1. Applicant and Administrator successfully completed Component II on 02/15/2024 and Component III during todays visit. Facility is approved for four (4) hospice (terminally ill) residents. The LPA toured the physical plant areas inside and outside with applicants to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in the closet in the hallway. The supply of perishable, nonperishable and emergency food supply observed sufficient. The supply of dishes, cups and utensils were adequate. Appliances in the kitchen were clean and all appeared functional. BEDROOMS: There are 4 bedrooms in the facility; three (3) shared rooms designated for residents and one (1) bedroom designated for staff. Lighting in the rooms appeared adequate; set up with beds, night stands, lamps, chests of drawers, chairs and closet space. BATHROOMS: There are two bathrooms; equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature tested at 107*f degrees which was within required range. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The facility smoke and carbon monoxide detector system is hard wired; all were operable at the time of the visit. There is a fireplace in the living room, which is appropriately screened. The fire extinguisher was fully charged and last serviced 07/2023. There is a functioning telephone on the premises. Emergency exiting plans/sketch observed posted; all other required postings are posted in the hallway upon entry into the facility. GARAGE: The laundry area is set up in the garage. Laundry detergent and chemicals are stored inaccessible in a cabinet. An additional refrigerator is in the garage with perishable items in good condition. GROUNDS: The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs for resident use. There are no bodies of water on the premises at the time. MEDICATIONS: Medications are in a locked cabinet in the dining/kitchen area. Complete first aid kit observed in locked cabinet in the garage. FILES: Staff and resident files are stored in a locked cabinet in the garage. Facility is in compliance with Title 22 Regulations at this time. The CAB Analyst will notify the applicant when the license has been approved. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Apr 3, 2024