Maryknoll Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by staff after explaining the purpose of the visit. Administrator (AD) Frances Amanda Umali was notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current and expires February 1, 2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents with a hospice waiver for four. The facility is a one story home with five resident bedrooms, one staff bedroom, a storage room, three bathrooms, and an attached garage. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPA observed residents watching television in the living room and resting in their respective bedrooms. LPA observed five residents in care and four staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the living room. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 108.9 and 113.3 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of May 4, 2026. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. LPA observed knives and sharps to be stored in a locked kitchen cabinet. Toxic chemicals, cleaning solutions, and disinfectants were observed to in an unlocked employee restroom; a deficiency was cited on today's date. LPA observed the First Aid Kit had all the required components. LPA observed the facility conducted their last emergency disaster drill on July 6, 2026 and is conducted every 3 months. During record review, LPA Guillen reviewed five resident records. All the required documentation were present and current in the resident files reviewed. LPA reviewed four employee records. All employees present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s inspection, a deficiency is being cited. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jul 20, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Jonas Navarro. Administrator (AD) Frances Amanda Umali was contacted by phone and arrived at approximately 9:30 a.m. and the purpose of the inspection was discussed. During the inspection, LPA and Staff Sandy Reyes conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with four resident bedrooms, two staff rooms, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 116.2-118.4 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated May 30, 2025. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA conducted record review of four resident files and two staff files. LPA interviewed two residents and three staff. (Cont. LIC809-C) Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 12, 2025

Allegation investigated: Licensee does not ensure facility is adequately staffed to meet resident's needs

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Administrator (AD) Frances Amanda Umali and explained the purpose of the inspection. It is alleged residents are left alone in the facility. Upon arrival, LPA observed two staff presently working at the facility. LPA obtained and reviewed a copy of Personnel Report (LIC500) and observed there to be staff coverage at all times. Interviews were conducted with four facility staff and four residents. During their interview, four of four residents denied the facility or residents being left alone or unattended, and stated staff is always present to assist. Four of four staff interviewed also denied facility or residents ever being left alone or unattended by staff. Per all four staff, in the event that staff need to run an errand or leave the facility, there is always an additional staff to stay at the facility to supervise and assist residents. (Cont. LIC9099-C) Unsubstantiated After a review of Personnel Report (LIC500) and due to allegation being uncorraborated during interviews conducted, LPA is unable to determine if Licensee does not ensure facility is adequately staffed to meet resident's needs. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Mar 26, 2025 · control 22-AS-20250324161418

Allegation investigated: Staff did not prevent resident from exposing herself while in the presence of other residents in care Staff did not prevent resident from having physical altercations with other residents in care

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analysts (LPAs) Claudia Gutierrez and Samer Haddadin regarding the allegations mentioned above. LPAs met with Administrator (AD) Frances Amanda Umali and explained the purpose of the inspection. Interviews were conducted with three facility staff, and three residents, regarding the allegation staff did not prevent resident from exposing herself while in the presence of other residents in care. Three of three staff interviewed denied any resident exposes themselves in the presence of other residents. Three of three residents interviewed denied exposing themselves to other residents and denied witnessing other residents exposing themselves. Interviews were conducted with three facility staff, and three residents, regarding allegation staff did not prevent resident from having physical altercations with other residents in care. (Cont. LIC9099-C) Unsubstantiated Three of three staff interviewed denied any facility residents having a physical altercation. Three of three residents denied personally having physical altercations and denied witnessing other residents having a physical altercation. Due to allegations being uncorroborated during interviews conducted, LPA is unable to determine if staff did not prevent resident from exposing herself while in the presence of other residents in care or if staff did not prevent resident from having physical altercations with other residents in care. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Aug 22, 2024 · control 22-AS-20240813083750

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Claudia Gutierrez and Samer Haddadin made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPAs met with Administrator (AD) Frances Amanda Umali and explained the purpose of the inspection. During the inspection, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with four resident bedrooms, two staff rooms, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPAs observed all resident beds had linens and blankets. LPAs observed all windows were screened. The backyard has a shaded sitting area. LPAs observed residents watching television in the living and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 107.2-108.5 degrees Fahrenheit. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service tag dated May 30, 2024. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents and stored in a locked cabinet. Medication closet was also observed to be locked. LPAs reviewed four resident files and four staff files. LPAs interviewed residents and staff present. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 22, 2024

Allegation investigated: Facility lacked supervision resulting in resident sustaining multiple fractures.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced and met with Administrator Frances Umali for the purpose of delivering the findings into the above allegation. On November 3, 2023, the Department received the complaint, and the investigation was initiated by LPA Joseph Alejandre on November 6, 2023. LPA Alejandre obtained records pertaining to Resident #1 (R1) during the initial visit. The investigation completed by the Department revealed the following: It is alleged that the facility lacked supervision resulting in the resident sustaining multiple fractures. Based on record review, R1 was admitted to the facility on August 14, 2019. The initial assessment for R1 documented the following conditions on the Physician’s Report dated August 23, 2019: Mild Cognitive Impairment, ambulatory without physical assistance, and requiring minimal assistance with their Activities of Daily Living (ADLs). Unsubstantiated Based on the interview, four out of the four staff indicated that R1 was provided and encouraged to use a walker however refused to use it, and the family member corroborated with this statement. Facility record shows R1 sustained injuries from two falls on October 17, 2022 and November 2, 2023. In between the one-year time frame, Staff #1 (S1) and the family member indicated that R1 had few minor slips from the chair or bed, however injuries were not sustained. The four other interviewed staff did not observe other falls. On October 17, 2022, R1 suffered a mechanical ground-level fall in the facility bathroom and sustained a fractured elbow and was subsequently placed on a cast as per the UCI Health medical report dated November 14, 2023. R1’s cognitive functions began to decline, and the Physician’s Report was updated to reflect R1’s change of condition on October 23, 2023. On November 2, 2023, approximately 9:00am, R1 suffered a mechanical fall in the living room and sustained closed fracture of multiple ribs of right side, facial injury, and a laceration of forehead per the UCI Health medical report dated November 14, 2023. Staff #2 (S2) present at the time of the incident indicated that R1 was using a walker. Four staff and one resident interviewed also confirmed that S2 was present during the fall. Based on the Department’s investigation, due to R1 being considered ambulatory from their most recent assessment dated October 23, 2023, and had not suffered from a fall or an injury for over one year, the evidence obtained did not support the allegation. In addition, the facility staff provided supervision and had taken appropriate measures to seek medical attention in a timely manner. Therefore, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Frances Umali, and a copy of this report including the LIC9099C, and the LIC811s were provided at the end of the visit.the state’s words, verbatim · CDSS document, Feb 15, 2024 · control 22-AS-20231103161201

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jessica Cho continued the visit after delivering the findings in connection to Complaint Control Number: 22-AS-20231103161201. LPA stated the purpose of the visit to Administrator Frances Umali. During the course of the complaint investigation mentioned above, LPA discovered that the Department did not receive a written report pertaining to the two falls Resident #1 (R1) suffered on October 17, 2022 and November 2, 2023. LPA obtained copies of the two incident reports on today's date. As a result of today’s Case-Management visit, a Technical Advisory note (LIC9102) will be issued. An exit interview was conducted with Frances Umali, and a copy of this report including the LIC9102 and LIC811 were provided at exit.the state’s words, verbatim · CDSS document, Feb 15, 2024

Allegation investigated: Staff took photos of resident without consent.

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility for the complaint received on 12/11/23 and to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by staff on duty (S1), and met with facility administrator (AD) Amanda Umali. During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. It was alleged that staff took photos of resident without consent. Per record review, it was observed that all 4 residents (R1, R2, R3, R4) and/or their responsible party signed a "Permission to Photograph" form upon admission. The document stated that R1, R2, R3, and R4, may be photographed for the following reasons: resident file, activities/parties, accidents/injuries. Unfounded LPA conducted 4 resident interviews, of which all resident interviews did not corroborate with the allegation by stating that they are aware of the consent for photo taking, and expressed no concerns. LPA conducted a total of 3 staff interviews, of which all 3 interviews did not corroborate with the allegation by stating that photos of the resident would not be taken, unless specified and given consent via signed Permission to Photograph form. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with AD Umali. A copy of this report was explained and provided.the state’s words, verbatim · CDSS document, Dec 14, 2023 · control 22-AS-20231211163815

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced case management visit to the facility and explained reason for the visit to facility administrator (AD) Amanda Umali. During the tour of the physical plant of the facility for complaint: 22-AS-20231211163815. LPA observed resident 1 (R1) room sealed and secured by the Placentia Police Department. LPA conducted record reviews and observed that AD completed and submitted a report to the Orange County Community Care Licensing Regional Office dated for 11/28/23. For today's visit, no citations were issued. An exit interview was conducted with AD. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Dec 14, 2023

Allegation investigated: Staff do not treat resident(s) in care with dignity. Staff do not ensure that resident(s) in care are provided with a sufficient amount of food. Staff discriminate against resident(s) in care.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the three allegations listed. LPA was greeted and granted entry by facility staff after explaining the reason for the visit. Facility administrator Amanda Umali was notified of the visit by telephone and read the report. An initial complaint investigation visit was conducted on September 13, 2023. LPA conducted or attempted interviews with the four residents present at the facility at the time of the visit. Resident records were requested, obtained and reviewed at the facility. A tour of the physical plant was conducted in the company of one of the three caregivers present. Two staff members including facility administrator were additionally interviewed during the visit. Additional witness interviews were later conducted by telephone. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff do not treat resident(s) in care with dignity, the following has been concluded: Based on observation and interviews with residents and witnesses, no personal rights concerns could be evidenced to be ongoing in the treatment of residents by staff members. Regarding the allegation that Staff do not ensure that resident(s) in care are provided with a sufficient amount of food, the following has been concluded: Based on the meals observed, meal plans and menus reviewed along with interviews with staff, residents and various witnesses, no evidence corroborating the fact that insufficient nutrition is being provided could be found. Finally, regarding the allegation that Staff discriminate against resident(s) in care, the following has been concluded: The residents and witnesses interviewed during the course of the investigation did not confirm any observed or perceived discrimination based on age or sex as alleged in the initial complaint. However, due to the absence of certain residents or impossibility to conduct some interviews, discrimination cannot be ruled out altogether. As a result, the allegations are therefore found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted by telephone and a copy of this report was provided after administrator gace permission to caregiving staff to sign on her behalf.the state’s words, verbatim · CDSS document, Oct 17, 2023 · control 22-AS-20230908155926