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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000638
Report Date: 01/29/2026
Date Signed: 01/29/2026 12:44:25 PM

Document Has Been Signed on 01/29/2026 12:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:3K HOME CAREFACILITY NUMBER:
306000638
ADMINISTRATOR/
DIRECTOR:		MARIA N.G. MANIMBOFACILITY TYPE:
740
ADDRESS:700 S. PLYMOUTH PLACETELEPHONE:
(714) 774-8653
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 0DATE:
01/29/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Maria Manimbo, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On this day with Licensing Program Analyst (LPA) Rose Ruppert met with Licensee Maria Manimbo for the purpose of conducting a case management deficiency visit regarding complaint control number 22-AS-20250805140648. During the investigation the following deficiencies were observed:

A solvency audit was conducted of the facility finances for the period of July 2024 to June 2025. Per the review, the Licensee’s net profit did not take into account salary and wages in cash to the employee and was therefore determined to be unreliable. Review of the Operating costs determined the licensee did not maintain sufficient cash reserves to cover any unforeseen expense for all twelve months reviewed.

The Department reviewed the Balance Sheet (LIC 403) for June 2025. Per review, $83.99 cash was in the financial institution and $11,450 was reported in current assets. The current assets reported were personal valuables, which the Department is unable to verify. The LIC 403 Balance Sheet listed $8,420.19 in liabilities. The balance sheet analysis shows that the working capital available for June 2025 is $83.99 in assets minus $8420.19 in liabilities with a working capital loss of -$8,336.18. Negative working capital indicates a company does not have enough current assets to cover short-term financial obligations.

Bank statements were obtained for the period of July 2024 through June 2025. Per review of facility finances, withdrawals exceeded deposits by $6,361.82 in July 2024, and $9,495.47 in June 2025. In addition, it was determined the Licensee did not have a separate business account and has comingled funds with their personal bank funds. In September 2024 and June 2025, there was a negative ending balance, which indicates the facility did not have enough funds to cover its expenses.

(Continued on LIC 809-C)
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: 3K HOME CARE
FACILITY NUMBER: 306000638
VISIT DATE: 01/29/2026
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(Continued form LIC 809)

Six months of utility bills and monthly lease payments were reviewed. While gas statements show the Licensee made payment in March and June 2024, telephone bills show payments were made late for all six months, which resulted in late fees. Electric, water and trash bills were provided every two months. Past due disconnections notices were sent on February, April and June 2024 billing statements. Monthly property lease payments for a twelve-month period were reviewed and the licensee made late payments for ten of the twelve months resulting in the licensee paying $1,450 in late fees.

Based on bank statements, utility bills, and facility records reviewed, it was determined the facility does not have sufficient cash reserve to cover operating expenses for one month and the licensee does not have a financial plan that complies with CCR Title 22 Section 87213, Finances.

During August 11, 2025 visit to facility, LPA observed Resident 1 (R1) file. Upon review, R1’s Admission Agreement on file was missing last page of R1’s original Admission Agreement containing R1’s signature was missing from file. During the investigation, text messages between R1 and the Licensee were obtained, asking for cash advances. LPA obtained text messages between R1 and the Licensee, asking for cash advances. R1’s Admissions Agreement stated rent is due by the 27th of the month. A screenshot of R1’s cell phone on April 28, 2025, states the Licensee provided the 1st Payment to a loan; taken from the resident. Prior to June 4, 2025, Licensee texted R1 for an advance for the month stating Licensee needed $2,000 for a referral fee for another resident. A screenshot on Wednesday, June 25, 2025, shows R1 wired $4,500 to Licensee’s bank account. Thus, R1 paid $6,500 for rent on June 2025 ($2000 + $4,500) before the 27th of June. Another text screenshot, on July 7, 2025, requests another advance for an undisclosed amount of money.

The Licensee currently acts as the facility Administrator and has an administrator certificate which expires on April 26, 2027. Despite this, they did not ensure the facility was in accordance with regulations and established policy, program and budget resulting in insufficient funds maintained and the Licensee borrowing funds from R1.

(Continued on LIC 809-C1)
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: 3K HOME CARE
FACILITY NUMBER: 306000638
VISIT DATE: 01/29/2026
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(Continued from LIC 809-C)

The following deficiencies are being cited per California Code of Regulations, Title 22 Division 6.

An exit interview was conducted with Maria Manimbo, Licensee and a copy of this report, LIC9099-D, and appeal rights were provided at the conclusion of the office meeting.
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/29/2026 12:44 PM - It Cannot Be Edited


Created By: RoseMarie Ruppert On 01/29/2026 at 10:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: 3K HOME CARE
FACILITY NUMBER: 306000638

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2026
Section Cited
CCR
87468.2(a)(8)

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Additional Personal Rights of Residents in Privately Operated Facilities… residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To be free from…, financial exploitation,… This requirement is not met as evidence by: Based on Dept. records
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Licensee (LE) will ensure personal funds and business funds are separate. LE will not ask for advance payment. or Loans. If requested by resident to pay in advance, LE will ensure proper documentation. LE will provide written documentation by signed self certification that LE understands this by POC due date.
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reviewed, observations & interviews, Text messages between Licensee and R1 confirm Licensee required advance payments from R1 on multiple occasions to help fund facility operations. This poses an immediate personal rights risk for persons in care.
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Type A
01/30/2026
Section Cited
CCR87213

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Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records;…This requirement is not met as evidenced by:
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LE will work on obtaining more clients to have sufficient funds to operate business. LE will ensure utility and business expenses are paid timely. LE will submit utility and business operating expenses by POC due date for all operating cost bills for January 2026 and will continue to provide proof of bills paid on
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Based on Dept. record review, observations and interviews the licensee failed to pay utility bills timely on multiple occasions and comingled Licensee’s personal funds and facility operating funds resulting in a negative working capital. This poses an immediate risk to residents in care.
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a quarterly basis.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
RoseMarie Ruppert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/29/2026 12:44 PM - It Cannot Be Edited


Created By: RoseMarie Ruppert On 01/29/2026 at 11:01 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: 3K HOME CARE
FACILITY NUMBER: 306000638

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2026
Section Cited
CCR
87507(d)

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Admission Agreements (d) The licensee shall retain in the resident's file the original signed and dated admission agreement... This requirement is not met as evidenced by: Based on Department record review and interviews the licensee did not retain the original signed and dated
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Licensee (LE) will retain original admission agreement and ensure all documentation, upon admission, are signed and completed. LE will submit signed, self-certifcation by POC due date.
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Admission Agreement for R1. During records reviewed, the last page of R1’s original Admission Agreement containing R1’s signature was missing from file. This poses a potential personal rights risk for residents in care.
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Type B
02/15/2026
Section Cited
CCR87405(h)(1)

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Administrator – Qualifications and Duties The administrator shall have the responsibility to: Administer the facility in accordance with these regulations and established policy, program and budget. This requirement is not met as evidenced by: Based on Department record review,
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LE will not comingle, borrow or ask for advances from any resident. LE will submit necessary documentation to designated a new administrator.
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observations and interviews, the Licensee borrowed money from a resident; co-mingled funds and failed to maintain a budget in accordance with regulations. This poses a potential safety and personal rights risk for residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
RoseMarie Ruppert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/29/2026 12:44 PM - It Cannot Be Edited


Created By: RoseMarie Ruppert On 01/29/2026 at 11:08 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: 3K HOME CARE
FACILITY NUMBER: 306000638

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2026
Section Cited
CCR
87205(a)

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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 is not met as
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Licensee (LE) will make a bank appointment for a business account. LE will ensure there are sufficient funds for facility operation LE will submit proof of completion by POC due date. LE agreed to receive Technical Support Program (TSP) services.
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 evidenced by: Based on Department record review, observations and interviews, the Licensee failed to maintain a budget in accordance with regulations and ensured facility compliance with Title 22. This poses a potential safety and personal rights risk for residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
RoseMarie Ruppert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2026


LIC809 (FAS) - (06/04)
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