<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600162
Report Date: 05/01/2025
Date Signed: 05/01/2025 12:50:17 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
03/26/2025 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250326163441
FACILITY NAME:ISMAELA'S HOME CARE, INC.FACILITY NUMBER:
415600162
ADMINISTRATOR:CHARITO RAFAELFACILITY TYPE:
740
ADDRESS:468 HAZEL AVENUETELEPHONE:
(650) 615-9937
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:6CENSUS: 6DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Licensee, Florinda GuintoTIME COMPLETED:
01:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing adequate laundry service.
Staff not allowing resident to shower.
Staff does not provide residents with nutritious meals, inadequate fruits, or vegetables.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 1, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced complaint visit to deliver the investigation findings. LPA met with the Licensee, Florinda Guinto and explained the purpose of the visit.

Regarding to the allegation of- staff not providing adequate laundry service, the reporting party stated that staff only does laundry once every 2 weeks and residents are running out of clean clothes.

As part of the investigation, LPA interviewed the Licensee and the residents.

According to the Licensee, laundry is done at the off-site Laundromat to save money on water bill and it was done every 2 weeks and on rainy days, it may be longer than 2 weeks.

LPA interviewed Resident #1 (R1) who stated that upon admission, R1 was told by the Licensee to purchase more clothes at least to last for 2 weeks because laundry was done every 2-3 weeks. R1 stated that there were times that R1 did not have clean clothes to wear.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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 5
Control Number 14-AS-20250326163441
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: ISMAELA'S HOME CARE, INC.
FACILITY NUMBER: 415600162
VISIT DATE: 05/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed Resident #2 (R2) who stated the laundry is done at the off-site Laundromat every 2-3 weeks and there were days that R2 ran out of clean clothes to wear as well.

After the investigation, this allegation is deemed to be substantiated as the facility is not providing adequate laundry service to meet the needs of the residents.

Regarding to the allegation of - staff not allowing resident to shower, the reporting party stated that the residents cannot shower daily.

As part of the investigation, LPA interviewed the Licensee, and residents.

LPA interviewed the Licensee who acknowledged that she has requested the residents to shower weekly to save money on water bill.

According to R1 and R2, they were asked by the Licensee not to shower daily to save money but they preferred to take a shower everyday or whenever they wanted to.

After the investigation, this allegation is substantiated.

Regarding to the allegation of - staff does not provide residents with nutritious meals, inadequate fruit or vegetables, the reporting party stated that resident are served waffles or 1 slice of spam for dinner. In addition, the reporting party stated that the facility was not providing fresh fruits and vegetables.

As part of the investigation, LPA conducted observation, interviewed the Licensee, and the residents.

During the 10-day complaint visit on 4/1/2025, LPA inspected the refrigerators and LPA did not observed 2-days of perishable and 7-days of non-perishable foods. LPA observed 2 bundles of celery, a few boxes of chicken and rice that were donated by Good Samaritan, many bags of bagel and bread that were also donated by the Good Samaritan, a bag of salad, a few bag of meats in the freezer that were separated and pre-bagged from a bulk purchase. LPA did not observed any other fresh vegetables, fresh produce items, seasonal fruits, etc.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 14-AS-20250326163441
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: ISMAELA'S HOME CARE, INC.
FACILITY NUMBER: 415600162
VISIT DATE: 05/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
According to the Licensee, the residents were served spam once a week for lunch and after reviewing the menu that was provided by the Licensee for breakfast, lunch and dinner, it was determined that the residents were served unbalanced meals for breakfast, lunch, and dinner.

LPA interviewed R1 who stated that they had to use their own money to purchase foods because it was not provided at the facility.

LPA interviewed R2 who stated the facility served vegetable and fruits but not enough varieties such as fresh season fruits, meats, and vegetables.

The Licensee was not able to provide grocery receipts to proof that adequate food items were purchased to ensure residents are provided with nutritious meals.

After the investigation, this allegation is substantiated.

Based on interviews, record reviews, and observations during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation was 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 was discussed with the licensee; a copy is provided with Appeal Rights provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 14-AS-20250326163441
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: ISMAELA'S HOME CARE, INC.
FACILITY NUMBER: 415600162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2025
Section Cited
HSC
1569.2(c)
1
2
3
4
5
6
7
Health and Safety Code section 1569.2(c) provides:.(c) "Care and supervision" means the facility assumes responsibility for,..Assistance includes assistance with taking medications, money management, or personal care.
1
2
3
4
5
6
7
The Licensee will develop a plan to ensure resident laundry is completed according to resident's needs and will provide a copy of the plan of correction to CCL by 5/9/2025.
8
9
10
11
12
13
14
This requirement is not met based on interviews and observations, the Licensee provided laundry services every 2-3 weeks resulted residents not having enough clean clothes to wear which poses a potential health risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 14-AS-20250326163441
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: ISMAELA'S HOME CARE, INC.
FACILITY NUMBER: 415600162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2025
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations,...
1
2
3
4
5
6
7
The Licensee will develop a plan in writing to ensure residents do not have any restrictions with their shower schedule. The Licensee will provide a copy of the plan to CCL by 5/2/2025.
8
9
10
11
12
13
14
The requirement is not met as evidenced by based on observation, and interviews, residents were requested by the Licensee not to shower as often as they desired to save money on water bill which poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
Type A
05/02/2025
Section Cited
CCR
87464(f)(3)
1
2
3
4
5
6
7
87464 Basic Services (f)Basic services shall at a minimum include:..(3) Three nutritionally well-balanced meals and snacks made available daily,...
This requirement is not met as evidenced by based on
1
2
3
4
5
6
7
The Licensee will develop a plan to ensure all residents are served three nutritionally well-balanced meals and snacks on a daily basis. The Licensee will provide a copy of the plan to CCL by 5/2/2025 and a copy of the grocery receipts.
8
9
10
11
12
13
14
observations and interviews, residents were not provided with fresh seasonal fruits, fresh vegetables, and different type of proteins to meet the resident's needs which poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
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: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5