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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410508866
Report Date: 03/28/2025
Date Signed: 03/28/2025 05:31:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2025 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250325164621
FACILITY NAME:CARE PLUS HOMEFACILITY NUMBER:
410508866
ADMINISTRATOR:ESTRELLA MANIOFACILITY TYPE:
735
ADDRESS:34 CAPAY CIRCLETELEPHONE:
(650) 225-9128
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 5DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
01:49 PM
MET WITH:Nenita Bactad & Edwin BactadTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility does not have a sufficient supply of food available
Staff do not adequately store food
INVESTIGATION FINDINGS:
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On 3/28/2025, LPA Grace Donato conducted an unannounced annual visit to the facility. LPA met with care staff Nenita Bactad & Edwin Bactad. LPA explained the purpose of the visit.

Regarding the allegation of facility does not have a sufficient supply of food available, Reporting Party (RP) stated that facility is not providing adequate food to the residents. RP visited the facility on 3/20/2025. The refrigerator was full of old food, some of which were visibly moldy; leftovers with no dates and a takeout box of fried chicken. It looked like everything was being shoved into the refrigerator and forgotten.

LPA interviewed staff members. S1 stated that they are given limited budget for the groceries. They go to do grocery every week. They are instructed to go to food banks to get more food supply. S2 also mentioned that since there is limited budget they sometines buy additonal food supply for residents out of their own pockets. S2 shared that the budget given to them is not enough to supply the menu that was provided to them.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 14-AS-20250325164621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CARE PLUS HOME
FACILITY NUMBER: 410508866
VISIT DATE: 03/28/2025
NARRATIVE
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LPA interviewed residents and 4 out of 4 mentioned that the food they get are good.

LPA checked the food supply of the facility and there is not enough 2 day perishable supply and 7 day non perishable. LPA also observed fried rice stored in plastic bags.

LPA was also able to obtain transcript of chat between staff and administrator regarding food supply. It states that they are encouraged to get more supply in food banks. In one of the messages, it was stated by the administrator to make one meal for less tha $5.

Therefore, based on interviews, observations and information collected, the above allegations are 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 and copy of report and appeal rights are provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20250325164621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CARE PLUS HOME
FACILITY NUMBER: 410508866
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2025
Section Cited
CCR
85076(d)(1)
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85076(d)(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.
This was not met as evidenced by:
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Licensee to submit an updated operating budget and a weekly menu to LPA. Licensee to also submit photos once groceries have been replenished. Licensee to submit by POC due date.
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Based on interviews and observation, facility does not have 2 day perishable and 7 day non perishable food supply for the residents, which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
03/29/2025
Section Cited
CCR
80076(a)(14)
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80076(a)(14) All foods or beverages capable of supporting rapid and progressive growth of microorganisms which can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C) or less.
This was not met as evidenced by:
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Licensee to submit photo of cleaned up and covered food that are stored in the refrigerator and update with dates on covers. Licensee to submit by POC due date.
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Based on observation, fried rice was stored in plastic bags, which poses an immediate health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3