Twin Hearts Senior Care II

Allegation investigated: Staff failed to properly care for the resident’s pressure injuries, resulting in worsening conditions.

On 7/10/2026, Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with staff Melati Wulansari and explained the purpose of the visit. The investigation consisted of staff interviews, hospice interviews and record reviews. The Licensee Kristine A. Mangente was contacted and informed about today’s visit. For the allegation,Staff failed to properly care for the resident’s pressure injuries, resulting in worsening conditions. During staff interviews, 2 out of 2 staff stated that proper care was provided to R1. It was revealed that R1 was on hospice and was receiving treatment for pressure injuries. In addition, the Registered Nurse confirmed they visited R1 and provided treatment for the pressure injuries and also confirmed that the injuries were not worsening. Nurse also confirmed that the pressure injuires were stage one and early-stages. Evidence shows that R1 was receiving treatment for pressure sores from Hospice. Unsubstantiated Based on the evidence obtained during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed with and provided to staff Melati Wulansari.the state’s words, verbatim · CDSS document, Jul 10, 2026 · control 56-AS-20260308204555

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced case management visit due to a request to change the facility capacity. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Administrator Kristine Mangente. A Change of Capacity application was received by the Department on May 2, 2025, in which the licensee requested a increase in capacity from six (6) non-ambulatory residents to five (5) non-ambulatory residents and one (1) bedridden resident. The Fire Safety Inspection Request was approved by the local fire authority on July 16, 2025. During today’s visit, LPA toured the facility and observed the residents in care. The facility sketch was consistent with the current layout of the facility. The completed change of capacity request will be forwarded to management for final review and approval. An exit interview was conducted with Administrator Kristine Mangente to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Staff Melati Wulansari. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Hospice waiver for six (6). During today’s inspection there were four (4) residents in care. Administrator Kristine Mangente arrived later during the visit. LPA with Administrator Mangente toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Windows, screens, toilets, and showers were in working order. LPA observed that the glass on the backdoor in Bedroom #1 was shattered on the first pane, with webs of cracks along its surface. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. The pool on the premises was gated and locked as required. Per Administrator Mangente, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC809-C] LPA reviewed facility records. Review of staff records revealed that Staff #1 (S1) did not have cardiopulmonary resuscitation (CPR) training and first aid training and they were the only staff member on the premises and on duty. Review of resident records revealed that Resident #1 (R1) had not received nor refused, if applicable, an annual route visit with a licensed medical professional once every twelve months. Confidential records were stored in locked areas. Two deficiencies were cited per California Code of Regulations, Title 22, and one deficiency was cited per Health and Safety Code (refer to the attached LIC 809-D). A plan of correction was jointly formulated, and an exit interview was conducted with Administrator Mangente, to whom a copy of this report, LIC809-C, LIC809-D and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Dec 8, 2025

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

On 5/21/2025, Licensing Program Analyst (LPA) Mary Rico and Licensing Program Analyst Manager (LPM) Efren Malagon met with Licensee Kristine A. Mangente at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office for an Informal Meeting. During today’s meeting the following matter was discussed of ownership and control of property: § Twin Hearts Senior Care II: § Twin Hearts Senior Care, LLC § ET Woodville Manor § A copy of Department of Labor § A copy of Corporation Active § Compliance of Annual Fee § Administrator Documents Licensee stated they will provide all copies to Community Care Licensing by 5/28/2025. An exit interview was conducted where this report, LIC809, LIC809D, were discussed and provided to Licensee Kristine A. Mangente. Along with a copy of appeal rights.the state’s words, verbatim · CDSS document, May 21, 2025

Allegation investigated: Staff violated resident's personal rights by not allowing visitors. Staff denied hospice services to resident.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with caregiver Juwita P. Elisabeth explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and resident interviews. For the allegation, Staff violated resident's personal rights by not allowing visitors. During staff interviews, all staff stated residents’ visitors are allowed to visit during facility hours but will accommodate with resident preferences. During residents' interviews, 1 out of the 5 residents stated their visitors have not been deny access. In addition, 4 out of the 5 residents were unable to corroborate on the above allegation. During record review, LPA Rico observed the facility has a designated visitor check-in. Unsubstantiated For the allegation, Staff denied hospice services to resident. During staff interviews, all staff stated they have not denied hospice services to resident. During resident interviews, 1 out of the 5 residents stated they do not require hospice services. In addition, 4 out of the 5 residents were unable to corroborate on the above allegation. Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to caregiver Juwita P. Elisabeth.the state’s words, verbatim · CDSS document, Feb 5, 2025 · control 56-AS-20231109085136

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 1/24/2025. LPA Rico met with caregiver Juwita P. Elisabeth and was granted entry to the facility. During today's visit, Administrator Kristine Mangente was contacted and informed of the visit. The following deficiencies were not cleared during the time of the visit: The Licensee was cited on 1/24/2025 the facility was cited on 87307(a) Personal Accommodation and Services. During today's facility tour, LPA observed S1 bed mattress is still located inside R1 bedroom closet. S1 confirmed they're still sleeping inside resident closet and facility living room. The Plan of Correction was to remove S1 bed mattress and provide proof to LPA Rico. In addition, the Administrator stated the facility does not have a designated room for staff, and will also allow staff to sleep in the living room. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (6) days. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Juwita P. Elisabeth.the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to verify clearance of Plan of Correction from visit on 1/24/2025. LPA Rico met with caregiver Juwita P. Elisabeth and was granted entry to the facility. During today's visit, Administrator Kristine Mangente was contacted and informed of the visit. The following deficiencies were not cleared during the time of the visit: The Licensee was cited on 1/24/2025 the facility was cited on 87307(a) Personal Accommodation and Services. During today's facility tour, LPA observed S1 bed mattress is still located inside R1 mattress closet. S1 confirmed they're still sleeping inside resident closet. The Plan of Correction was to remove S1 bed mattress and provide proof to LPA Rico. Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (3) days. The Licensee was cited on 1/24/2025 the facility was cited on 87608(a)(5)(B) Postural Supports. During today's facility tour, LPA observed 3 out of the 6 residents had full bed rails. The Plan of Correction was to remove the full bed rails and train staff on the regulation cited. In addition, provide proof to LPA Rico.Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (3) days. The Licensee was cited on 1/24/2025 the facility was cited on 87355(e)(3)Criminal Record Clearance. During today's facility tour, and record review. LPA Rico observed S1 and S2 working without having their criminal record clearance associated to the facility. The Plan of Correction was to associate S1 and S2 clearance to the facility and send proof to LPA Rico.Therefore, the POC was not cleared at the time of the visit. Civil penalties will be assessed in the amount of $100 per day for (3) days. An exit interview was conducted and this report, LIC809 along with Civil Penalty Assessment pages, and Appeal Rights were reviewed and provided to caregiver Juwita P. Elisabeth.the state’s words, verbatim · CDSS document, Jan 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with staff Juwita Pratiwi Elisabeth and was granted entry to the facility. Licensed capacity is (6) current census (6). LPA was accompanied by Licensee/Administrator Kristine Mangente to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to resident in care. There was a designated space for resident/staff files. LPA observed a swimming pool in backyard, gate was safely secured by locked iron a gate around the perimeter. During facility tour, LPA observed a bed mattress inside R1 closet. Licensee confirmed staff sleep inside resident closet to. LPA requested mattress to be removed. In addition, LPA Rico observed 3 out of the 6 residents had full rails and they are not in hospice. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. . Record Review: LPA reviewed (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (6) resident medications. During medication audit, LPA Rico observed the facility did not have (6) resident’s PRN response documented and maintained in the resident's MAR. Licensee stated the facility does not have hospice residents. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed the facility did not have S1 and S2 associated to the facility. Lastly, the facility did not conduct an emergency drill for over six months. Based on the observations made during today’s visit, (5) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. The facility was also issued a Civil Penalty in an amount of $1,000. An exit interview was conducted, and this report (LIC809(LIC809D)(LIC421BG) was discussed and provided to Administrator Kristine Mangente. Along with a copy of Appeal Rightsthe state’s words, verbatim · CDSS document, Jan 24, 2025

Type of visit: Case Management - Other

On 08/24/2024 at 08:45 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a Case Management Visit. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there were two (2) staff present, and six (6) residents present. Licensee/Administrator Kristine Mangente was contacted and informed of the visit. Licensee/Administrator Mangente arrived during the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Mangente. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has six (6) Hospice Waiver. The current census is six (6) residents. LPA Brown was accompanied by Staff #2 (S2) and Licensee/Administrator Mangente to conduct a Case Management visit, which included, but was not limited to the following: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. ***Continuation in LIC809C *** Moreover, during the tour of the facility, LPA Brown observed multiple bottles of chemicals not locked, and accessible to residents in care. Deficiency will be issued. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 109 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Furthermore, during the tour of the facility, LPA Brown observed Staff #2 (S2) working at the facility with criminal background clearance but S2 criminal background clearance was not transferred to the facility. Deficiency will be issued and civil penalty will be assessed of $500.00 and will continue to be assessed of $100.00 until corrected. Also, LPA Brown observed Staff #3 (S3) working at the facility without criminal background clearance. Deficiency will be issued and civil penalty will be assessed of $500.00 and will continue to be assessed of $100.00 until corrected. Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. The facility has an administrator present in the facility. LPA Brown did not observed sufficient number of staff to provide care and supervision to the residents in care as no staff scheduled to work the night shift as required for facility with dementia residents. Deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Kristine Mangente.the state’s words, verbatim · CDSS document, Aug 24, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 18, 2024

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the multiple bottle of chemicals under the sink were locked which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 24, 2024

Plan of correction: Licensee immediately removed and locked the multiple bottles of chemicals under the sink during the visit. Plan of Correction (POC) cleared. Licensee stated to train all staff on CCR 87309(a) and submit proof of training log to LPA Brown on POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(d)(3) · Plan of correction due date: Aug 25, 2024

87355(d)(3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Staff #3 (S3) obtain a criminal background clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 24, 2024

Plan of correction: Licensee stated to remove Staff #3 (S3) at the facility today and submit an updated Personnel Summary (LIC500) without S3 on schedule to LPA Brown on POC due date. Licensee stated to obtain S3 criminal background clearance before allowing S3 to work back at the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Aug 25, 2024

87705 Care of Persons with Demetia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that there's a staff scheduled to work the shift, awake and on duty as required for facility with dementia residents which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 24, 2024

Plan of correction: Licensee stated to submit an updated staff schedule/Personnel Summary (LIC500) showing that there's a night shift staff working at the facility, awake and on duty to LPA brown on Plan of Correction (POC) due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(3) · Plan of correction due date: Sep 3, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Staff #2 (S2) criminal background clearance was transferred at the facility prior to employment which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 24, 2024

Plan of correction: Licensee stated to transfer S2 criminal background clearance to the facility and submit proof to LPA brown on POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Kristine Mangente and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents. The current census is six (6) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathrooms to be at 112.2 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to the residents in care. There was a designated storage space for resident files and staff files. The medications are stored inside a closet near the living room inaccessible to the residents. During medication review, LPA found that the Resident’s R1, R2, R3, and R4 had medications that were removed out of their originally received prescription containers and were being stored in a plastic container cups. The facility will be issued a deficiency for not storing the resident’s medications in the original prescription containers. Non-perishable and perishable food supply is sufficient for the residents in care. The pool and spa in backyard is locked and inaccessible to the residents. LPA reviewed six (6) residents files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC811, and LIC809D were discussed and provided to Administrator Kristine Mangente, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Feb 16, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced case management visit during complaint control number 56-AS-20231109085136. LPA met with Caregiver Isidoro Villarente and explained the reason for the visit. During today visit, LPA requested staff files for staff S1 and Staff S2. LPA was informed that S1 and S2 do not have a staff file at the facility. LPA requested resident files for resident R1, R2, and R3. LPA was informed that R1, R2, and R3 do not have a resident file at the facility. Based on observations today, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Caregiver Isidoro Villarente, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Nov 13, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Nov 17, 2023

87506. Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Based on interview, observation, and document review the licensee did not comply with the section cited above evidenced by not having a resident file for resident R1, R2, and R3 in the facility which poses a potential health, safety, or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Nov 13, 2023

Plan of correction: The licensee has agreed to read regulation 87506 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to create a file for resident R1, R2, and R3 with all the required documents listed in regulation 87506. The POC is due by 11/17/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Nov 17, 2023

87412 Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: Based on interview, observation, and document review the licensee did not comply with the section cited above evidenced by not having a staff file for staff S1 and S2 in the facility which poses a potential health, safety, or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Nov 13, 2023

Plan of correction: The licensee has agreed to read regulation 87506 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to create a file for staff S1 and S2 with all the required documents listed in regulation 87412. The POC is due by 11/17/2023.