Tlc Home Care

Type of visit: Required - 1 Year

On 3/4/2026 Licensing Program Analyst (LPA) Grace Donato made an unannounced annual visit to the facility. LPA met with staff Alex Lumbera and LPA spoke with Licensee Lily Mauricio over the phone. LPA explained the purpose of the visit. LPA toured the facility inside and outside including resident rooms, common areas, garage & bathrooms. The indoor and outdoor passageways were free of obstruction. The residents have adequate amount of linens in their bedrooms. All personal belongings are intact. While touring the facility it was observed that the room temperature was at 72 deg F. Bathroom water temperature is at 118 deg F. Resident bedrooms and bathrooms were observed to be in good repair. Bathrooms are equipped with grab bars and non-skid floors and mats. Carbon monoxide monitor are working properly. All fire extinguishers have been checked and current. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Sharps and chemicals are locked and inaccessible to residents. Emergency drill is done quarterly. Medication are locked and centrally stored medications are updated. Four resident records and three staff records were reviewed. 3 staff members have incomplete training requirements, 2 of which don't have the required 40-hour initial training and 1 don't have 20-hour annual training. LPA requested the following: LIC 500 LIC 610D Control of Property Liability Insurance An immediate civil penalty of $500 was assessed due to a staff member not having a fingerprint clearance and is currently working in the facility. Deficiencies are cited under the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in Civil Penalties. A copy of this report along with Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 4, 2026

Allegation investigated: Staff are falsifying documents

On December 17, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Facility Manager, Lourdes Mauricio and explained the purpose of the visit. Regarding the allegation, staff are falsifying documents, according to the reporting party, on October 20, 2025, staff used Staff 1's (S1's) initials to sign the Medication Administration Record (MAR) even though S1 was not working that day. According to the reporting party, he/she stated that facility staff are not giving the medication to the residents. During the investigation, LPA reviewed facility's MAR, interviewed staff, and reviewed staff schedule. Staff schedule reviewed showed that S1 was not working on 10/20/25, however based on facility's MAR reviewed, S1's initials were observed on the MAR on 10/20/25 indicating that S1 provided medication to Resident 1 (R1). According to staff interviewed, they were unsure why R1's MAR had S1's initials on 10/20/25. Based on interviews and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation is determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Facility Manager, Lourdes Mauricio and a copy is provided with appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Dec 17, 2025 · control 14-AS-20251112101102

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Dec 18, 2025

87207 False Claims: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This regulation is not met as evidenced by: Based on records reviewed, S1 was not working on 10/20/25, however LPA observed S1's initials signed on R1's MAR on 10/20/25. According to staff interviewed, they are unsure why R1's MAR had S1's initials for 10/20/25.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: Licensee/administrator shall submit a plan in writing describing how licensee will ensure that staff are at all times disseminating truthful statements regarding the facility and operations.

Type of visit: Case Management - Deficiencies

On December 17, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit in relation to complaint control #: 14-AS-20251112101102. LPA met with Caregiver, Alex Lumbera and explained the purpose of the visit. During the complaint investigation, LPA reviewed facility's centrally stored medication record and conducted medication count for Resident 1-4 (R1-R4). LPA did not conduct medication count for Resident 5 (R5) as according to staff interviewed and documents reviewed, R5 is on hospice and the facility does not administer medication to R5. Based on centrally stored medication record reviewed for R1-R4, the facility failed to ensure that the centrally stored medication record was updated and corresponded with the residents' medication list as prescribed by the physician. In addition, when conducting medication count, LPA observed the amount of medications in the bottle did not correspond with the start date of the medication listed on the centrally stored medication record. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with the Facility Manger and a copy is provided with appeal rights.the state’s words, verbatim · CDSS document, Dec 17, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(6) · Plan of correction due date: Dec 18, 2025

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes... This requirement is not as evidenced by: Based on record reviewed, Licensee failed to ensure that residents' centrally stored medication record (CSMR) is current and logged. In addition, when conducting medication count, LPA observed the amount of medications in residents' bottles did not correspond with the start date of the medication listed on the CSMR which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: Licensee/administrator shall update all 4 residents' CSMR to reflect physician's medication list. All updated CSMR shall be submitted to CCLD with all 4 residents' current medication list prescribed by physician.

Type of visit: Required - 1 Year

On 3/4/2024 Licensing Program Analyst (LPA) Grace Donato made an unannounced annual visit to the facility. LPA met with staff Josephine Manzano. LPA explained the purpose of the visit. LPA toured the facility inside and outside including resident rooms, common areas, garage & bathrooms. The indoor and outdoor passageways were free of obstruction. The residents have adequate amount of linens in their bedrooms. All personal belongings are intact. While touring the facility it was observed that the room temperature was at 75 deg F. Bathroom water temperature is at 118 deg F. Resident bedrooms and bathrooms were observed to be in good repair. Bathrooms are equipped with grab bars and non-skid floors and mats. Carbon monoxide monitor are working properly. All fire extinguishers have been checked and current. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Sharps and chemicals are locked and inaccessible to residents. Emergency drill is done quarterly. Medication are locked and centrally stored medications are updated. Two resident records and two staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirements. Facility accepts hospice residents and are in compliance with the required waiver requirements. No citations issued today. Report is reviewed with and a copy is provided.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Case Management - Legal/Non-compliance

On 11/21/24, Licensing Program Analyst (LPA), Grace Donato conducted an unannounced case management- legal/non-compliance inspection to monitor the facility operation. LPA met with Caregiver, Josephine Manzano, and explained the purpose of the visit. A non-compliance conference was held on November 9, 2023. During non-compliance meeting, the following violations were discussed: Criminal Record Clearance, Emergency Drills, Administrator - Qualifications and Duties. During the visit, LPA toured the facility and checked on residents. Some residents are currently watching tv in the living room. LPA reviewed the emergency drill in-service training, which happened this November 2024. All staff have criminal record clearance and are associated with the facility. Needs and service plan of residents are updated and current LIC500 was received. No citations issued today. Report is reviewed with and a copy is provided.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Case Management - Legal/Non-compliance

On 8/23/24, Licensing Program Analyst (LPA), Grace Donato conducted an unannounced case management- legal/non-compliance inspection to monitor the facility operation. LPA met with Caregiver, Josephine Manzano, and explained the purpose of the visit. A non-compliance conference was held on November 9, 2023. During non-compliance meeting, the following violations were discussed: Criminal Record Clearance, Emergency Drills, Administrator - Qualifications and Duties. During the visit, LPA toured the facility and checked on residents. Some residents are being assisted with activities of daily living, some residents are currently resting in their respective rooms after having lunch. LPA reviewed the emergency drill in-service training, which happened last July 2024. All staff have criminal record clearance and are associated with the facility. Needs and service plan of residents are updated and current LIC500 was requested. No citations issued today. Report is reviewed with and a copy is provided.the state’s words, verbatim · CDSS document, Aug 23, 2024

Type of visit: Case Management - Legal/Non-compliance

On 6/12/24, Licensing Program Analyst (LPA), Grace Donato conducted an unannounced case management- legal/non-compliance inspection to monitor the facility operation. LPA met with Caregiver, Josephine Manzano, and explained the purpose of the visit. A non-compliance conference was held on November 9, 2023. During non-compliance meeting, the following violations were discussed, Criminal Record Clearance, Emergency Drills, Administrator - Qualifications and Duties. During the visit, LPA reviewed the emergency drill in-service training, all staff have criminal record clearance and are associated with the facility. Needs and service plan of residents are updated and current LIC500 was requested. No citations issued today. Report is reviewed with and a copy is provided.the state’s words, verbatim · CDSS document, Jun 12, 2024

Type of visit: Required - 1 Year

On 3/4/2024 Licensing Program Analyst (LPA) Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Bernice Mauricio-Orme. LPA explained the purpose of the visit. LPA toured the facility inside and outside including resident rooms, common areas, garage & bathrooms. The indoor and outdoor passageways were free of obstruction. The residents have adequate amount of linens in their bedrooms. All personal belongings are intact. While touring the facility it was observed that the room temperature was at 71 deg F. Bathroom water temperature is at 112 deg F. Resident bedrooms and bathrooms were observed to be in good repair. Bathrooms are equipped with grab bars and non-skid floors and mats. Carbon monoxide monitor are working properly. All fire extinguishers have been checked and current. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Sharps and chemicals are locked and inaccessible to residents. Emergency drill is done quarterly. Medication are locked and centrally stored medications are updated. Five resident records and five staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirements. Facility accepts hospice residents and are in compliance with the required waiver requirements. No citations issued today. Report is reviewed with and a copy is provided.the state’s words, verbatim · CDSS document, Mar 4, 2024

Type of visit: Case Management - Legal/Non-compliance

On 01/23/24, Licensing Program Analyst (LPA), Grace Donato conducted an unannounced case management- legal/non-compliance inspection to monitor the facility operation. LPA met with Caregiver, Josephine Manzano, and explained the purpose of the visit. A non-compliance conference was held on November 9, 2023. During non-compliance meeting, the following violations were discussed, Criminal Record Clearance, Emergency Drills, Administrator - Qualifications and Duties. During the visit, LPA reviewed the emergency drill in-service training, all staff have criminal record clearance and are associated with the facility. Needs and service plan of residents are updated and current LIC500 reflects schedule where Administrator is at the facility with a sufficient number of hours. No citations issued today. Report is reviewed with and a copy is provided.the state’s words, verbatim · CDSS document, Jan 23, 2024

Type of visit: Office

On November 9, 2023, San Bruno Regional Office conducted a non-compliance conference meeting with Licensee, Lilia Mauricio & Administrator Jason Pineda. Present in the meeting was Regional Manager, Vivien Helbling, Licensing Program Managers, Cara Smith and April Cowan, Licensing Program Analysts, Grace Donato, Audrey Jeung and John Calandra. Long Term Care Ombudsman, Robert Lewetzon was also present in this meeting. During non-compliance meeting, the following violation was discussed, Criminal Record Clearance, Emergency Plans, Administrator - Qualifications and Duties. During this meeting, it was discussed, Community Care Licensing will increase frequency monitoring inspection visits to ensure compliance with this compliance plan of Title 22 regulation. licensee was provided the link below for resources and guidance to improve facility operations: https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers Deficiencies are cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report was reviewed with Licensee/Administrator, Lilia Mauricio and a copy of this report and the Appeal Rights are provided.the state’s words, verbatim · CDSS document, Nov 9, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: Nov 13, 2023

ACCOUNTABILITY OF LICENSEE GOVERNING BODY The licensee... shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met , as licensee failed to operate facility in conformance with regulations, which poses an immediate health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 9, 2023

Plan of correction: Plan of correction to be submitted to CCLD BY DUE DATE, in which licensee shall ensure that facility operates in conformance with these regulations

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.58(a)(2) · Plan of correction due date: Nov 13, 2023

Persons prohibited from being a licensee...(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This H&S regulation has not been met as evidenced by: The licensee is currently providing unlicensed care to another facility which jeopardized the residents' health and safety and the care and supervision of the residents in care.the state’s words, verbatim · CDSS document, Nov 9, 2023

Plan of correction: The Licensee shall comply with the regulation stated herewithin and other agencies of such a change in the future. A written statement of such shall be received by the POC date stated.