Mary's Manor

Type of visit: Required - 1 Year

On 09/17/2025 at 9:10 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Satvinder Kaur, and explained the purpose of the visit. Administrator, Mary Sunderraj, gave authorization on the phone for staff to sign the report. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 bedrooms in total of which 4 bedrooms are occupied by the residents, 1 bedroom is occupied by staff, and one office. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents shared bathroom was measured at 107.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors in operating condition during visit. Fire extinguisher was last serviced on 11/06/2024. Emergency Disaster Plan was last posted on 09/03/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 07/11/2025. At 10:27 AM, LPA reviewed 6 residents records. At 10:58 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. At 12:30 PM, LPA reviewed 4 samples of residents’ medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/03/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Infection Control Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:15 AM, LPA observed both bathrooms not cleaned and R5's room with a strong urine odor. At 9:17 PM, LPA observed broken patio furniture in the backyard. At 9:29 AM, LPA observed Lysol wipes in the office, disinfectant spray in the hallway, and Tide Pods in resident's room unlocked and accessible to residents in care. At 9:45 AM, LPA observed unlocked medications such as eyedrops, Miralax, Gummies, Tums, Levothyroxine, Ointment, etc., in all the residents’ room. At 10:30 AM, first aid kit was not observed. Continue to LIC809-C... Continue from LIC809-C... At 12:30 PM, an interview with staff revealed that R3 had an incident and was not reported to licensing. At 1:06 PM, observation and interview revealed that the facility does not have a carbon monoxide detector. At 1:16 PM, a record review showed that the facility did not have updated training for S3 and S4 on file. At 1:41 PM, interview with staff stated that R1 does not have a doctor's order for the half bedrail. At 1:45 PM, S4’s personnel file was not at the facility. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 17, 2025

The state marks this report as 15 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 01/16/2025, at 9:00 AM Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla conducted an unannounced Case Management visit regarding deficiencies that was observed during annual visit on 09/19/2024. LPAs met with Caregiver, Satvinder Kaur and explained the purpose of the visit. Satvinder phoned, Licensee/Administrator, Mary Sunderraj, to inform. Administrator came shortly. During the annual inspection conducted on 09/19/2024, the facility was issued a citation on failure to provide doctor's order for use of half rails for R2, R3, and R4 with a Plan of Correction due on 10/10/2024. During the visit, Administrator stated that R2, R3, and R4 do not need the half rails and removed the half rails. Administrator stated that she will obtain a new Physician's Report for R4 if needed upon hospital discharge. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Case Management - Other

On 10/03/2024 at 11:00 AM Licensing Program Analysts (LPAs) L. Alexander and P. Manalo conducted an unannounced Case Management Plan of Correction visit regarding deficiencies that was observed during annual visit on 09/19/2024. LPAs met with Caregivers, Satvinder Kaur and Ravinder Singh and explained the purpose of the visit. Satvinder phoned, Licensee/Administrator, Mary Sunderraj, to inform. LPAs spoke with Mrs. Sunderraj who was not available to come to the facility. Mrs. Sunderraj gave authorization for Satvinder to sign report. During the 09/19/2024, LPAs was informed by the Administrator that there was a Bedridden resident, R6, that was discharged from Kaiser Fremont Medical Center. Administrator stated that resident was only going to be at the facility for five (5) days. Licensee did not have a fire clearance for Bedridden. LPAs toured the facility and observed that there were six (6) residents at the facility. LPAs observed that R6 has moved out. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 3, 2024

Type of visit: Required - 1 Year

This is an amendment to an original LIC809 report issued on 09/19/24. On 09/19/2024 at 12:35 PM, Licensing Program Analysts (LPAs) L. Alexander and Patricia Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Licensee/Administrator, Mary Sunderraj and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of six (6) and hospice waiver for three (3). Administrator Certificate #60011363740 expired 06/28/2023. Administrator provided a copy of faxed re-certification on 05/24/2023. LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of total 4 bedrooms which 4 bedrooms are occupied by the clients and a partitioned area bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 74 degree Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygiene supplies were available for clients. There is a minimum of one week supply of nonperishables and 2-day perishables food supply. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 11/28/2023. Emergency Disaster Drill was last posted on 03/03/2024. First aid kit was observed to be complete. LIC809-C Continued... LIC809-C Continued... 5 of 6 clients’ records were reviewed. 3 staff records were reviewed, and 3 of 3 have current first aid training and associated to the facility. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/26/2024: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 400 Affidavit Regarding Client/Resident Cash Resources LIC 402 Surety Bond LIC 610D Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 19, 2024

The state marks this report as 16 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.