St. Anne's Home for Elderly

Type of visit: Required - 1 Year

On 7/29/2026, the Licensing Program Analyst (LPA) Grace Donato arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Maylene Manalo, and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, kitchen area and backyard. LPA observed a small storage shed at the back of the facility. While touring the facility it was observed that the room temperature was at 71 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed locked. Food supply in kitchen and garage refrigerator was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill is done every quarter. Three resident records and two staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. No citations issued today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Office

Licensing Program Analyst Manuel Monter and Licensing Program Manager Romeo Manzano conducted an Office visit with Administrator Melinda Manalo. The purpose of the visit is to discuss an annual inspection report and non ambulatory fire clearance of the facility (Bedroom #5). During today's visit, LPM discussed the annual inspection report, dated July 22, 2025. During inspection R1 was observed occupying bedroom #5, which is an ambulatory room. R1 is considered non-ambulatory, based on his/her physician's report (health condition). Licensee/ADM stated R1 has been provided a 60 day eviction notice on August 5, 2025. R1 refused to leave the facility. A review of the current STD850, the facility has been approved for 4 non ambulatory, 1 bedridden, and 1 ambulatory. CCLD will issue a new license, reflecting the fire clearance. ADM stated that upon talking to fire department inspector, she was informed that bedroom #5 was cleared to be non ambulatory by the fire department inspector. LPM and ADM contacted the fire inspector to verify the ambulatory status of bedroom #5. Fire inspector stated bedroom #5, in its current state will not be approved for a non-ambulatory bedroom, because there is no direct door. ADM hired an architect, who inspected the facility and will submit the plan to the city for the construction of a door in bedroom #5. Licensee/ ADM was advised to inform CCLD when construction will begin. ADM stated she will submit a written plan of action, to ensure care and supervision of residents in care, while the construction process for bedroom #5 is underway. Once construction has completed, ADM will contact the Department for a new fire clearance request. Page 1 Out of 2. ADM stated resident R1 will be staying in another RCFE, in a non ambulatory bedroom for a respite, while there is ongoing construction and change of ambulatory status for bedroom #5. R1 has agreed. After the construction and change of ambulatory status, R1 will return to the care home. This report will be shared with San Bruno Regional Office Managers. No deficiencies cited. This report was reviewed with Administrator Melinda Manalo. A copy of this report was provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Required - 1 Year

On July 22, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Maylene Manalo, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had five (5) residents in care and (2) staff members present at the time. The Licensee, Melinda Manalo joined shortly after. At 9:15 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. LPA inspected the kitchen and found it clean, with no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. One (1) resident was observed eating breakfast. LPA inspected the living room and observed it clean, with all furniture in good repair. There were chairs, tables, and a television in the living room. There were five (5) bedrooms and four (4) bathrooms designated for residents' use. All five (5) resident rooms were single occupancy. LPA inspected all resident rooms and found them clean, well-lit, and equipped with the required furniture. Continued on LIC809-C At 9:38, LPA observed that non-ambulatory residents R4 and R5 in room #5 and room #2 respectively. Room #2 and #5 didn’t have an approved fire clearance for non-ambulatory residents. LPA inspected two (2) bathrooms and found them sanitary, and in good working conditions. The bathrooms contained soap, grab bars, a trash can, a shower chair, and non-slip flooring/mats. The hot water temperature at the sink faucet in both bathrooms was measured between that range of 119.4°F to 119.6°F. LPA inspected the fire extinguisher mounted on the wall in the hallway next to dining area and found it fully charged, with the last service tag dated 01/16/2025. The smoke and carbon monoxide detector located in the living room was tested and it was found to be functional. Additional smoke detectors were observed in all bedrooms and common areas of the facility during the visit. LPA inspected the (2) storage closets in the hallway and observed them contained clean linens, blankets, and towels for residents’ use. LPA inspected the laundry/utility area and found it clean. A washer, a dryer, and a refrigerator, a freezer containing additional food supplies, and a pantry cabinet with non-perishable food items were observed. LPA toured the front porch and backyard areas, and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The porch and backyard had a table, chairs, and shaded areas for resident use. Detergents, disinfectants, and cleaning supplies were observed in a locked cabinet in the backyard. No bodies of water were noted. LPA inspected (1) storage shed in the backyard and noted incontinence supplies, paper tissues, and other supplies stored. At 10:30 AM, LPA reviewed three (3) staff personnel records and five (5) resident records. The LPA observed that 3 of 5 residents were not seen by a physician in the last 12 months and 1 of 5 residents did not have the pre-admission appraisal. LPA observed that 3 of 3 staff members had LIC 508 Criminal Record Statements, LIC 503 Health Screening, and confirmed that 3 of 3 staff members were associated with the facility. At 11:50 AM, LPA observed a locked centrally stored medication cabinet next to the dining area. Medications were organized in separate bins for each resident. Centrally Stored Medication Records were reviewed and LPA observed 1 of 5 residents (R1) medication that was administered to R1 was not entered/logged in the Centrally Stored Medication Records. Continued on LIC809-C LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were not conducted quarterly, with the most recent drill completed on 06/20/2023. The following updated forms are requested to be submitted to CCLD by 07/29/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with the Licensee, Melinda Manalo, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 22, 2025

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Maylene Manalo. During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the locked storage areas for medications, sharp objects, and cleaning supplies. The first aid kit was observed and found to be complete. LPA toured 5 out of 5 resident bedrooms and observed each bedroom to have working lights and available bedding and clothing storage areas. LPA Marrufo tested the smoke detectors in the living room, hallway, and 5 out of 5 resident rooms. A smoke detector in one of the bedrooms had a very faint sound. The smoke detector in the living room had a constant chirping sound during visit. The rest of the smoke detectors functioned properly when tested. LPA Marrufo tested one out of one carbon monoxide detector and it functioned properly when tested. LPA toured the outside area and found the outdoor exit to be clear of obstructions. LPA Marrufo reviewed 4 out of 4 resident Centrally Stored Medication and Destruction Records (CSMDR). One resident does not take medications. Resident R1 was missing 3 medications in the CSMDR and resident R2 was missing 2 medications in the CSMDR. LPA reviewed 5 out of 5 resident records. Resident R1 was missing an Appraisal/Needs and Services Plan. R2's record was missing an Appraisal/Needs and Safeguard for Property and Valuables (SPV) form. Resident R3 was missing an Emergency Contact and Information Form, Appraisal/Needs and Services Plan, SPV, and LIC613C Personal Rights form. LPA Marrufo reviewed 2 out of 2 staff records and found them to be complete. Advisory Notes were issued. See LIC9102 for more information. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Maylene Manalo and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 2, 2024