Monteverde Manor II

Type of visit: Case Management - Other

On July 29, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management -other visit. LPA met with caregiver, Remus Buensuceso and LPA explained the purpose of today's visit. Caregiver contacted the administrator/licensee over the phone and informed him of LPA's visit. During today's visit, LPA toured the facilty with caregiver, and LPA observed all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. During today's visit, LPA also requested for a copy of the liability insurance as the copy on file has expired on June 2026 and this observation was reported to the administrator/licensee during the annual inspection on 4/16/2026. The administrator reported that he was working on it with the insurance company. On June 1, 2026, LPA requested for a copy of the current liability insurance and the administrator/licensee stated that he was still working on it with the insurance company. The administrator also requested for documents from CCL that were requested by the insurance company and those documents were provided. Subsequently, LPA has been following up with the administrator/licensee via phone calls and written communication, however, as of today, the administrator/licensee was not able to provide a copy of the current liability insurance. Deficiency is cited under Health and Safety Code, Title 22 Division 6 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with caregiver, Remus Buensuceso. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 29, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Aug 5, 2026

1569.605 Liability insurance; coverage requirements... Based on interview, observation and record review, This requirement is not met as evidenced by the facility did not provide a copy of the current liability insurance after several verbal and written reminders which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: The administrator/licensee stated that a copy of the current liability insurance will be provided to by the end of the day. The administrator will submit a plan of correction to ensure that this does not happen again and will provide a copy of the plan to CCL by 8/5/2026.

Type of visit: Office

An informal meeting was convened in the San Bruno regional office today. In attendance are: - License/Administrator Dino Martin - Licensing Program Manager April Cowan - Licensing Program Analyst Murial Han The following concerns are discussed: - Fire Clearance pertaining to bedridden resident residing in Non-bedridden approved room - Administrator qualifications - Repeat violations from annual inspections from 2023 to 2026 - Liability Insurance - Administrator Re-certification During today's meeting, we reviewed the repeat violations that were cited during the annual inspections from 2023- 2026. The administrator/license has agreed to resubmit the plan of correction for 87202(a)(2)- Fire Clearance by 5/7/2026 and the administrator/license will submit a statement to ensure the facility is in compliance. Due to the above findings and observations, the facility will be placed on quarterly monitor for 2 years. This report is reviewed and discussed with the administrator. A copy is provided.the state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: POC

On April 29, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced plan of correction visit to follow up on a civil penalty that was assessed on 4/22/2026. LPA met with administrator, Dino Martin and LPA explained the purpose of the visit. The administrator left the facility shortly after LPA's entry and the rest of the visit was conducted with caregiver, Remus Buensuceso. On April 22, 2026. LPA conducted an unannounced plan of correction visit to follow up on the citations that were issued during the annual visit on April 16, 2026. During the visit, LPA observed 87412(a)(13)(B) was not corrected as staff #2 (S2) was working at the facility without a criminal background clearance and due to the citation not being corrected by 4/17/2026, a civil penalty in the amount of $500 was assessed from 4/18/2026 through 4/22/2026. During today’s visit, LPA observed S2 is now cleared and associated with the facility, Civil penalty will be stopped on 4/23/2026. This report is reviewed and discussed with caregiver, Remus Buensuceso. A copy is provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

Type of visit: Case Management - Deficiencies

On April 29, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management visit. LPA met with administrator, Dino Martin and LPA explained the purpose of the visit. The administrator left the facility shortly after LPA's entry and the rest of the visit was conducted with caregiver, Remus Buensuceso. During the annual visit on 4/16/2026, LPA requested for a copy of the current administrator certification to be submitted to CCL by 4/27/2026. On 4/28/2026, LPA followed up with the administrator for the above request and the administrator stated that he did not have a current administrator certification and he is in the process of renewing it. Based on observation interview and record review, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with caregiver. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Apr 30, 2026

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...this requirement is not met as evidenced by the administrator's certificate has expired which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: The administrator/ licensee will develop a plan to ensure that the administrator completes the re-certification process in a timely fashion. In addition, the licensee will appoint an acting administrator for the facility while the administrator is working on the renewal process. The administrator will provide a copy of the plan of correction to CCL by 4/30/2026. The administrator will provide documents to CCL by 5/8/2026 to proof that the renewal process is completed.

Type of visit: POC

On April 22, 2026, Licensing Program Analyst (LPA) Murial Han conducted a plan of correction visit. LPA met with administrator, Dino Martin and LPA explained the purpose of today's visit. On 4/16/2026, during the annual inspection, the facility was cited for 87412(a)(13)(B)- as LPA observed staff #1 (S1) and staff #2 (S2) did not have criminal background clearance resulting in the administrator calling for 2 new staff to replace S1 and S2 during the inspection. During today's visit, LPA observed S1 was criminal background cleared but S2 was not. Due to the above observation and deficiency not being corrected, a civil penalty is being assessed in the amount of $100 a day from 4/18/2026 through 4/22/2026 and will continue to accrue until corrected. A total civil penalty of $500 is being assessed. The administrator stated that S2 will be removed from the facility until the criminal background clearance process is completed. In the meantime, the administrator will stay until additional staff arrives at the facility. This report is reviewed and discussed with the administrator. A copy of the report and appeal rights were provided,the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Required - 1 Year

On April 16, 2026 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregivers Remus Buensuceso and Maria Buensuceso and LPA explained the purpose of the visit. The administrator, Dino Martin arrived shortly thereafter and assisted with the inspection. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA toured inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable at this time. Chemical, and sharps cabinets were observed to be locked and inaccessible to residents in care. However, Medication cabinets were unlocked and accessible to residents in care. The facility is approved for 1 bedridden resident in room 4,and LPA observed resident #6 (R6) who was deemed to be bedridden on the LIC 602 was residing in room 2 that was not approved for bedridden resident. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Emergency drills were reviewed to be adequate. A review of (6) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. During the review of staff files, LPA observed staff #1 (S1 ) and Staff #2 (S2) did not have a criminal background clearance. LPA spoke with the administrator who brought additional staff members to the facility and S1 and S2 were removed. Civil penalty is being assessed today for the following citations in the amount of $1500 - 87202(a)(2) Bedridden Persons- $500 - 87412(a)(13)(B) Criminal Background Clearance- $1000 The following forms and documents were requested to submitted to CCL by 4/27/2026: - liability insurance, Administrator Certification, LIC 500 and Lease Agreement Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in addition civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 16, 2026

Type of visit: POC

On April 9, 2025, Licensing Program Analyst (LPA) Murial Han conducted a plan of correction visit for the annual inspection that was conducted on April 1, 2025. LPA met with caregiver, Ilfonso Maning and explained the purpose of today's visit. The administrator arrived and assisted with the visit. During today's visit, LPA toured the common areas, garage, bath/shower room, dining room, living room, resident room, etc., reviewed plan of correction documents that were submitted by the administrator/licensee. The following deficiencies , which were cited on 4/1/2025 are corrected: - 87202(a)(2) Fire Clearance - 87305(a) Alterations to Exiting Buildings or New Facilities - 87456(a)(2) Evalution of Suitability for Admission - 87507(a) Admissions Agreement - 1569.695(c) Other Provisions - 1569.695(d) Other Provisions - 87608(a)(3) Postural Supports - 87463(a) Reappraisals A copy of the Cleared Plan of Correction Letters were provided the administrator/licensee. No deficiency cited today. This report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Case Management - Annual Continuation

On April 9, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced continuation visit for an annual inspection that was conducted April 1, 2025. LPA met with caregiver, Ilfonso Maning and explained the purpose of today's visit. The administrator arrived and assisted with the inspection. During today's visit: LPA reviewed 3 staff files, reviewed documents and conducted facility tour that was provided by the caregiver. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

On April 1, 2025 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, ILdefonso Maning and explained the purpose of the visit. The administrator, Dino Martin arrived shortly thereafter and assisted with the inspection. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Chemicals, medication and sharps cabinets were observed to be locked and inaccessible to residents in care. A tour of the resident bedrooms and restrooms was conducted. The facility is approved for 1 bedridden resident in room 4, however, LPA observed resident #5 (R5) who is bedridden and is residing in room 1 that is a non-approved bedridden room. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. There are 5 residents present. Garage area was toured. LPA observed the facility has been converted into a storage space and for staff members to rest/sleep. LPA observed 2 beds in the garage with personal items around it and according to staff #1 (S1) staff members sleep and take rest breaks and the garage door has been broken for a long time. Fire extinguishers were inspected on 10/4/2024. Facility was not able to provide documentation to proof that emergency drills were completed accordingly. A review of (5) resident files was conducted and noted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL by 4/2/2025 - liability insurance Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in addition civil penalties. Civil penalty is being assessed today for the following repeat violations: - 87202(a)(2) Bedridden Persons - 87463(a) Reappraisals - 87305(a) Alterations to Existing Building - 1569.695(c) Other Provisions/Disaster Preparedness LPA will return on another day to complete the inspection. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 1, 2025

Type of visit: Required - 1 Year

On April 17, 2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, ILdefonso Maning and explained the purpose of the visit. The administrator, Dino Martin arrived shortly thereafter and assisted with the inspection. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication and sharps cabinets were locked located in the kitchen area and inaccessible to residents in care. A tour of the resident bedrooms and restrooms was conducted. The facility is approved for 1 bedridden resident in room 4, however, LPA observed 1 bedridden resident is residing in a non-approved bedridden room. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. A comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. There are 6 residents present, and 3 staff but 1 staff left during the inspection due to lack of criminal background clearance. A review of (5) facility resident records was conducted. A review of (4) facility staff records was conducted. Garage area was toured. LPA observed half of the garage was blocked off by green partition with two tents inside; each tent consisted of a mattress and around the tents, there were toiletries, clothing, shoes, etc. The administrator acknowledged that the facility altered this space as facility staff living space without permit. The garage area also housed the washing machine and dryer for this facility's use at this time. Laundry area was toured. Cabinets storing detergents and bleach were observed to be unlocked and accessible to the residents at this time. Fire extinguishers were inspected on 10/26/2023. Facility was not able to provide documentation to proof that emergency drills were completed accordingly. The following forms and documents were requested to be updated and submitted into CCL by 4/22/24 - control of property, and liability insurance Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Civil penalty is being assessed today for repeat violation, lack of criminal background clearance for one staff, a bedridden resident is residing in a room that is not cleared by fire marshal and 2 out of 4 staff members were not associated. Civil penalty will continue to accrue until corrected. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 17, 2024

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 10/15/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregivers, Sonny Maning and Marife Maning, who were requested to go ahead and contact the facility designated Administrator to inform him/her that CCL was present at this time. The facility Administrator, Mary Juinio, arrived later to this facility while this LPA was conducting this annual visit. A brief interview was conducted with the facility Administrator at this time. Current census was 5 residents. It was learned that there was (1) resident under the care of hospice at this time. This facility was approved for a hospice waiver to be able to accept and retain up to (3) residents under hospice care at any given time. It was learned that there were (2) residents deemed to be bedridden at this time. There was (1) resident under the care of home health at this time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Dino Martin. The administrator certificate was due to expire on 12/28/2024 and in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility caregiver Sonny Maning. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area also housed the washing machine and dryer for this facility's use at this time. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguishers (2), located in facility entrance walkway garage area, were reviewed to see if they had been annually inspected, or recently purchased, by the local fire extinguisher company at this time. They were observed to have been annually inspected on 09/29/2022 by All Peninsula Fire Extinguisher Co. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (5) facility resident records was conducted. A review of (4) facility staff records was conducted. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility co-Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Oct 15, 2023