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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 410508866
Report Date: 03/02/2026
Date Signed: 03/02/2026 03:15:08 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
11/17/2025 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251117151146
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: 0DATE:
03/02/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Elissa JonesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is unkempt
INVESTIGATION FINDINGS:
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On 3/2/2026, Licensing Program Analyst (LPA) Grace Donato arrived at the facility to deliver conclusionary findings for this complaint received on November 17, 2025. LPA Donato was greeted by Administrator Elissa Jones and explained the purpose of the visit.

Complaint alleged that facility is unkempt. According to the reporting party, the facility uses dog pee pads as table cloths in the dining room and R1’s bedroom and a malodorous smell was observed. During LPA Calandra’s initial visit on 11/19/2025, LPA observed that the facility was using diapers as placemats in the dining room and a wet/used diaper was observed on R1’s bed.

Based on the LPA’S observations, 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, are being cited on the attached LIC9099D.

Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties.

An exit interview was conducted and a copy of the report along with Appeal Rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026
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-20251117151146
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: 03/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2026
Section Cited
CCR
80087(a)
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80087: Building and Grounds: (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement is not met as evidenced by:
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Licensee/Administrator has closed the facility.
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Based on observation, Licensee used adult diapers/pee pads as placemats at the facility’s dining room table, which poses a potential 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: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
11/17/2025 and conducted by Evaluator Grace Donato
COMPLAINT CONTROL NUMBER: 14-AS-20251117151146

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: 0DATE:
03/02/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Elissa JonesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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2
3
4
5
6
7
8
9
Facility did not have completed resident files
INVESTIGATION FINDINGS:
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4
5
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7
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9
10
11
12
13
On 3/2/2026, Licensing Program Analyst (LPA) Grace Donato arrived at the facility to deliver conclusionary findings for this complaint received on November 17, 2025. LPA Donato was greeted by Administrator Elissa Jones and explained the purpose of the visit.

Complaint alleged that facility staff did not have completed resident files. According to the reporting party, when they asked for R1’s files the staff were unable to provide said documents. During LPA’s visit on 11/19/2025, LPA Calandra asked for R1’s file and was provided the following required documents: ID page, LIC 602: Physician’s report, Appraisal of Needs and Services, Admissions Agreement, and Personal Rights form.

Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to the facility representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3