Tara Manor

Allegation investigated: Resident sustained a fracture while in care

On 12/17/2025 , LPA Grace Donato conducted a complaint investigation visit to deliver findings. LPA met with Rose Veridiano & Rommel Dionson and explained the purpose of the visit. Regarding the allegation of Resident (R1) sustained a fracture while in care, On 1/18/2025, R1 was sent to the hospital due to a swollen left thigh. During the investigation, staff members were interviewed, and records were reviewed. Based on Day Program staff interviews and documents, R1 attended regular program on 01/17/2025 and returned to facility. Staff recalled R1 being at baseline. Staff perform two “full-body checks” on all their incontinent clients to ensure the client does not have any injuries, rashes, or abnormalities before the client returns home. Staff recalled R1’s left leg to be intact without any signs of injury or discomfort. page 1 of 2 Substantiated Based on facility notes, R1 did not have any falls, injuries, or redness until 01/18/2025. On 01/18/2025, it notes thigh is swelling and looked weightless after moving while changing. Based on staff statements and facility documents, R1 was last seen in normal physical condition on 01/18/2025, at around 9am, and was found by S1 with a left thigh injury between 1100-1150pm. Staff denied R1 falling out of bed or having an accident while using the Hoyer lift. Staff denied R1 hitting his/her leg against the bed or another resident assaulting R1. Staff denied assaulting R1 and staff did not know how R1 sustained the injury. Based on the findings, R1 sustained an unexplained femur fracture while in care at the facility. At the time of the complaint inspection on 12/17/2025 licensee was informed that the incident is currently under review and a future civil penalty may apply based on Health and Safety Code §1569.49. Based on interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC-9099D. An immediate $500.00 was assessed today due to R1 sustaining unexplained injury while in care. Report is reviewed and a copy of the report and Appeal Rights is provided.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 14-AS-20250210113400

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 18, 2025

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidenced by: Based on interviews and records review, R1 sustained an unexplained injury while in care which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: Licensee to do an in-service training about care and supervision of residents, postural supports and mandatory reporting. Licensee to submit by POC due date.

Type of visit: Required - 1 Year

LPA Jeung toured facility and grounds, including two detached storage sheds. This is a 2-story building; staff occupy the 2nd floor and clients reside on the ground level, where there are 2 shared and 2 private client bedrooms, two kitchens, living and dining rooms, foyer, and two full bathrooms. On the upper level, there are large open spaces for living and family rooms, full kitchen, 3 bedrooms for staff--one room has 2 beds, another room has one bed for one staff, and the master bedroom has one bed for 2 staff, with an adjacent full bathroom--and second full bathroom. There is no garage. Washer and dryer are located on ground level utility room. Wooden ramp in the backyard accesses 2nd floor. No residents are present. No accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, and a comfortable temperature is maintained. Bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested in clients' bathroom at 107 degrees. Food supply and first-aid kits are inspected. An Emergency Disaster Plan is posted. Client files are reviewed, including clients' Centrally Stored Medication Records. All clients are ambulatory, and all but one are under age 60. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Stephanie Veridiano and Rommel Dionson are certified RCFE administrators (x 4/27 & 5/27) that oversee facility operations. Continued on following page. The following forms are requested to be updated and returned to CCL by 11/13/25: • LIC 309 Administrative Organization • LIC 500 Personnel Report • Corrected facility sketch/floor plan for ground floor The following updated information is provided to LPA today: - proof of current surety bonding - proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, are observed and cited on a following page. See also Technical Advisory Note--one page.the state’s words, verbatim · CDSS document, Oct 30, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Oct 30, 2025

CRIMINAL RECORD CLEARANCE All individuals subject to a criminal record review pursuant to HSC 1569.17(b) shall prior to working, residing or volunteering in a licensed facility obtain a CA clearance or a criminal record exemption as required by the Dept. This requirement was not met, as criminal record clearance for staff #6 is not associated to facility. Licensee failed to ensure that criminal record clearance for S6 was reinstated when he resumed work at facility, which posed an immediate health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Criminal record clearance for staff #6 was reassociated to facility in LPA's presence. Deficiency corrected and cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a) · Plan of correction due date: Oct 31, 2025

STORAGE SPACE ... the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances..., and other similar items which could pose a danger to residents are in locked storage... This requirement is not met, as several paint cans are stored in unlocked storage shed in backyard. Licensee failed to ensure that paint is inaccessible to clients, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Detached storage shed will be locked so paint is not accessible to clients. Proof of correction to be sent to CCLD BY DUE DATE

Type of visit: Case Management - Incident

On 1/23/2025, Licensing Program Analyst (LPA) Grace Donato conducted a case management visit concerning an incident report received. LPA met with Administrator Stephanie Veridiano & Co-Administrator Rommel Dionson. LPA explained the purpose of today's visit. On 1/21/2025, LPA received an incident report regarding a resident (R1) having moderate swelling on the upper leg with slight green discoloration on the left inner upper leg. R1 was then transferred to Zuckerberg San Francisco General Hospital & Trauma Center. Facility reported the incident to Police and APS but was told that since there is no perpetrator they are not able to start an investigation. LPA interviewed staff. S1 said that R1 had a change in diaper at around 6am, diaper was removed at 8am and R1 had a pad on the bed. Through the diaper changes there was no swelling observed up until 11am. Based also on records review, there is no observation of resident having swelling from when R1 arrived from day program the day before. R1 has had an old fracture of distal & femoral shaft. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

On 9/25/24 LPA Grace Donato made an unannounced pre-licensing visit to the facility. LPA met with Caregiver Maria Badiola and Program Coordinator Rommel Dionson & Administrator Stephanie Veridiano followed after. LPA toured the facility inside and outside including all of resident rooms and kitchen area. LPA observed one resident in the living room. Other residents currently in day program. While touring the facility it was observed that the room temperature was at 69 deg F. Hot water was also tested in the bathrooms and the temperature was 108 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 and inaccessible to residents. Food supply in 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. Five resident records and five staff records were reviewed. Resident’s PNI money was counted and all accounted for. Staff have criminal record and fingerprint clearances on file. Staff have current First Aid/CPR certifications on file. Resident records were reviewed and were observed to be complete. Centrally stored medication was locked in the medicine cart and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. Licensee submitted the following: LIC 500 Personnel Report & LIC 308. No deficiencies are cited at this time. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Sep 25, 2024

Type of visit: Post Licensing

On 11/27/23 LPA Grace Donato made an unannounced pre-licensing visit to the facility. LPA met with Program Coordinator Rommel Dionson, Administrator Stephanie Veridiano & Co-Administrator Rosemarie Veridiano. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. No residents currently in the facility due to residents being in day programs. Carbon monoxide monitor is working properly. All fire extinguishers have been checked and current. Client bathrooms were observed to be in good repair equipped with grab bars and non-skid mats. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Resident records are updated, complete and signed. Staff records are complete, with training logs. Component III is conducted on this day. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Nov 27, 2023

Type of visit: Prelicensing

On 10/23/23 LPA Grace Donato made an unannounced pre-licensing visit to the facility. LPA met with Caregiver Maria Badiola and Program Coordinator Rommel Dionson & Administrator Stephanie Veridiano followed after. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. No residents currently in the facility due to residents being in day programs. LPA observed paint buckets & slabs of wood covered with tarp since facility is being repainted and repaired. Facility will clean up in 2 weeks after all the work is finished. The residents have adequate amount of linens and all personal belongings are intact. While touring the facility it was observed that the room temperature was at 71 deg F. Hot water was also tested in the bathrooms and the temperature was 110 deg F. Carbon monoxide monitor is working properly. All fire extinguishers have been checked and current. Client bathrooms were observed to be in good repair equipped with grab bars and non-skid mats. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Three client records and three staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Facility is clean and in good repair based on observations made today. Facility is in compliance with Title 22 regulations. No citations are issued. No deficiencies are cited at this time. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Oct 23, 2023