415601111-7-23-2024-14-AS-ACON-D7PTT5-20240731150009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601111
Report Date: 07/23/2024
Date Signed: 07/23/2024 01:57:17 PM

Unsubstantiated

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
07/16/2024 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240716163615

FACILITY NAME:	MANALO'S BOARD & CARE IV		FACILITY NUMBER:	415601111
ADMINISTRATOR:	MANALO, JOSEFINA		FACILITY TYPE:	740
ADDRESS:	2595 OAKMONT AVE.		TELEPHONE:	(650) 868-1901
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	8	CENSUS: 8	DATE:	07/23/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator, Josefina Manalo		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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An unknown amount of cash is missing from R1

INVESTIGATION FINDINGS:

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On July 23, 2024, Licensing Program Analyst (LPA), Murial Han completed a 10-day complaint visit. LPA met with the administrator and explained the purpose of today's visit.

Regarding to the allegation of an unknown amount of cash is missing from resident #1 (R1), the reporting party stated that there was a former caregiver who took R1's money and also asked other responsible parties for additional money.

As part of the investigation, LPA interviewed facility staff, the administrator and reviewed documents.

According to staff #1 (S1) who did not know that the former staff (S2) was asking residents and family members for money until S2 left the facility. S1 also stated that S2 asked him/her for money and has yet paid back the full amount that was lend to S2.

LPA interviewed the administrator who stated the facility did not know that S2 was asking residents and family members for money until they overheard a conversation between some of the family members outside of the facility. When the administrator learned about the incident, the administrator started the investigation and discovered that S2 took $1300 dollars from R1 and also recevied money from varies family members. The administrator notified the Local Police Department, the Ombudsman, and all the family members..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 14-AS-20240716163615

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 & CARE IV	FACILITY NUMBER: 415601111
	VISIT DATE: 07/23/2024

NARRATIVE

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The administrator stated that the facility did not know that R1 was keeping cash in his/her room. In addition, the administrator stated that the facility did not handle resident's cash and the responsible parties were informed upon admission not bring any cash and valuables to the facility.

The administrator was not able to provide a copy of R1's personal belonging list, however, LPA observed a written communication between the administrator and R1's responsible party indicated that the administrator had no knowledge that R1 was keeping cash in his/her room.

After the investigation, this allegation is deemed to be unsubstantiated. Although there was cash missing from R1, the administrator was able to proof that the facility did not have any knowledge that R1 was keeping money in his/her room.

During the process of the investigation, LPA observed 6 out of 8 residents did not have a completed Client/Resident Personal Property and Valuables form. This observation will be cited on LIC 809 and LIC 809D under case management.

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

Exit interview conducted with the facility's Administrator. A copy of this report was provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC9099 (FAS) - (06/04)

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