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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600646
Report Date: 07/31/2025
Date Signed: 07/31/2025 03:33:03 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
07/09/2025 and conducted by Evaluator Grace Donato
COMPLAINT CONTROL NUMBER: 14-AS-20250709160500
FACILITY NAME:MANALO'S BOARD AND CARE VFACILITY NUMBER:
415600646
ADMINISTRATOR:MANALO, JOSEFINAFACILITY TYPE:
740
ADDRESS:840 ALTA LOMA DRIVETELEPHONE:
(650) 868-1901
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 6DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Coelestis ChanTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff did not dispense medication to resident as prescribed.
INVESTIGATION FINDINGS:
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On 7/31/2025, Licensing Program Analyst (LPA), Grace Donato conducted an announced complaint investigation visit. LPA met Administrator Coelestis Chan, and explained the purpose of today's visit.

Regarding the allegation of Staff did not dispense medication to resident as prescribed, RP states on 06/29/2025 and 07/04/2025, he/she observed R1s medication had a half pill left in the bottle. RP states she is unsure what happened to cause half a pill to be left over, but R1s prescription calls for him/her to receive a whole pill.

Based on observations, when LPA checked the bottle of pills for R1s medication, it was noted that there was a half pill on it. LPA took photos. Centrally store medication records stated that each pill is equal to 1 doze to be given daily. No instructions for cutting it to half.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
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 7
Control Number 14-AS-20250709160500
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: MANALO'S BOARD AND CARE V
FACILITY NUMBER: 415600646
VISIT DATE: 07/31/2025
NARRATIVE
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ADM added during the interview that morning medications were prepared by the night staff, and the ADM was not made aware of the medication containing a half pill.

Based on interviews and observation, the above allegation is 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 the report and appeals rights is provided.

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SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 14-AS-20250709160500
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: MANALO'S BOARD AND CARE V
FACILITY NUMBER: 415600646
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2025
Section Cited
CCR
87465(c)(2)
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87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions.
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Licensee to submit a plan to address the medication issue and to do in-service training for staff regarding medication. Licensee to submit to LPA by POC due date.
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This was not met as evidenced by:

Based on interviews, records review and observations, R1s medication had a half pill in the bottle where it’s indicated that the dosage is 1 pill daily once a day, 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: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
07/09/2025 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250709160500

FACILITY NAME:MANALO'S BOARD AND CARE VFACILITY NUMBER:
415600646
ADMINISTRATOR:MANALO, JOSEFINAFACILITY TYPE:
740
ADDRESS:840 ALTA LOMA DRIVETELEPHONE:
(650) 868-1901
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 6DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Coelestis ChanTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff handled resident in a physically inappropriate manner.
Staff did not assist residents with obtaining medical care services.
Licensee did not provide planned activities for residents.
INVESTIGATION FINDINGS:
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On 7/31/2025, Licensing Program Analyst (LPA), Grace Donato conducted an announced complaint investigation visit. LPA met Administrator Coelestis Chan, and explained the purpose of today's visit.

Regarding the allegation that staff handled resident in a physically inappropriate manner, the Reporting Party (RP) stated that resident (R1) disclosed that he/she is afraid of the bathroom because he/she is forced to shower and handled roughly by staff. RP states there is a lot of violence happening when residents are showered, with residents punching, scratching, biting, and kicking caregivers, then caregivers defending themselves.

LPA interviewed RP and confirmed the allegation, it was also stated that RP is unsure how the caregivers defend themselves exactly, but staff (S1) told RP that staff (S2) once put up his/her fist.

page 1 of 3
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 14-AS-20250709160500
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: MANALO'S BOARD AND CARE V
FACILITY NUMBER: 415600646
VISIT DATE: 07/31/2025
NARRATIVE
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RP states he/she is unsure if S2 actually hit a resident but R1 once said he/she was beaten in the shower, however RP did not ask R1 who beat him/her. LPA also interviewed staff, S1 denied saying anything about S2 putting up a fist to R1. S1 also shared R1 always has two showers a week and additional ones if needed. R1 is very combative but it takes a lot of patience when they shower R1. S2 mentioned that R1 is combative but listens to him/her most of the time. S2 assists when R1 gets showers because of combative behavior. S2 denied ever hitting R1 or any resident. S3 also added that with R1, it always has to be a 2 person assist for showers due to the behavior. LPA attempted to interview R1 but he/she was not able to give coherent answers to the LPA.

Based on records review, the facility has been constantly updating their progress notes regarding R1. There are entries about R1 having combative behaviors during showers, very uncooperative and refusing medications, but staff are still able to provide the needs for activities of daily living for the resident.

LPA was also able to obtain police report records. It was stated in the report that there is no merit to the allegations of elder abuse. The facility is neat and clean. The patients at the facility were properly clothed, had no signs of visible injury, and appeared to be adequately fed.

Regarding the allegation of staff did not assist residents with obtaining medical care services, RP stated that R1 screams constantly and needs hearing aids. RP states the facility has not made any attempt to have R1s hearing evaluated by a medical professional to determine if he/she needs hearing aids.

Based on records review, R1 has been checked by the R1s physician at least twice during the duration of the stay and there were no references about the hearing being an issue.

Based on observation, during the LPA visit, when care staff are talking to R1, they are talking in a low voice and asking if R1 needs any help. R1 responds with no issues and can clearly hear what that care staff was telling R1. During the LPAs attempt to interview R1, he/she was responsive even when the LPA was asking questions in a regular voice.

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SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 14-AS-20250709160500
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: MANALO'S BOARD AND CARE V
FACILITY NUMBER: 415600646
VISIT DATE: 07/31/2025
NARRATIVE
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Regarding the allegation of Licensee did not provide planned activities for residents, RP states the residents just watch television all day because the facility does not provide any activities for them like games or books.

During the interviews, S2 stated that they do some exercises in the morning. ADM also stated that they try to provide some activities and try to involve residents but most of them don’t want to participate. S2 mentioned walking the residents out in the morning. S2 also added that 2 of the residents just prefers to chat.

Based on records review, facility provided a copy of the activities initiated by care staff everyday.

Based on interviews and records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and copy is provided.

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SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
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
07/09/2025 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250709160500

FACILITY NAME:MANALO'S BOARD AND CARE VFACILITY NUMBER:
415600646
ADMINISTRATOR:MANALO, JOSEFINAFACILITY TYPE:
740
ADDRESS:840 ALTA LOMA DRIVETELEPHONE:
(650) 868-1901
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:6CENSUS: 6DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Coelestis ChanTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility did not report incident to licensing
INVESTIGATION FINDINGS:
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On 7/31/2025, Licensing Program Analyst (LPA), Grace Donato conducted an announced complaint investigation visit. LPA met Administrator Coelestis Chan, and explained the purpose of today's visit.

Regarding the allegation of Facility did not report incident to licensing, RP states approximately one month ago (date not recalled), R1 had a bandage on the left hand that RP believes was from an injury R1 sustained while being showered by caregivers.

LPA interviewed the staff and S2 & S3 mentioned that, yes R1 had a bandage but that bandage was just a band aid that R1 put on. They described the band aid as just being placed there by R1 just a like a kid who puts on band aids even if there is no wound.

LPA observed both hands of R1 and there is no bruise or traces of wound in it.

Based on interviews and observations, this allegation was false, could not have happened and/or is without a reasonable basis.therefore the allegation is UNFOUNDED.

No deficiencies cited today. Report is reviewed and copy is provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 7