435202100-5-22-2026-26-AS-RMAO-DURUBK-20260605152626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202100
Report Date: 05/22/2026
Date Signed: 05/22/2026 03:05:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2025 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20250815163726

FACILITY NAME:	MASTEN CARE HOME		FACILITY NUMBER:	435202100
ADMINISTRATOR:	JHANELLE GUICO		FACILITY TYPE:	735
ADDRESS:	375 FITZGERALD AVE.		TELEPHONE:	(408) 846-8985
CITY:	SAN MARTIN	STATE: CA	ZIP CODE:	95046
CAPACITY:	6	CENSUS: 4	DATE:	05/22/2026
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator, Jhanelle Guico		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not provide proper care and supervision to resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator, Jhanelle Guico and stated the purpose of today’s visit.

On 08/15/2025, the Department received a complaint with the above allegations. On 08/18/2025, the Department conducted an initial investigation at the facility.

Continuation on LIC 9099-C, Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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 26-AS-20250815163726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MASTEN CARE HOME	FACILITY NUMBER: 435202100
	VISIT DATE: 05/22/2026

NARRATIVE

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Page 2 of 3.

Staff did not provide proper care and supervision to resident in care.
It was alleged that the facility staff were not providing the necessary care and supervision to resident R1 as R1 had a wound on left pinky toe.

On 03/03/2026, the Department interviewed facility staff (S1-S4). 4 Out of 4 staff stated R1 has paralysis on the left side of the body where in R1 has “clubfoot” to the left foot. They stated R1 “scoots” in wheelchair around the facility wherein the left foot scrapes the floor. They stated a licensed home health agency provides incidental care to the wound on left foot. They stated R1 is prescribed a foam pad for the clubfoot, but R1 would always take it off.

On 03/03/2026, the Department interviewed residents (R1-R4). R1 was not able to respond verbally or nonverbally to questions asked about this investigation. 3 Out of 3 residents stated he/she feel safe at the facility and staff assist them when needed.

On 03/09/2026, the Department interviewed nurse (RN) from licensed home health agency overseeing R1’s care at the facility. RN stated the wounds on R1’s foot are not considered pressure injuries as R1 is not bedridden and can rotate on their own. RN stated R1 had blisters on left foot and toes from hitting the floor when R1 scoots. RN stated the last two visits, R1’s blister on left foot was healing slowly.

Based on review of R1’s nurses’ notes from 8/7/2025, R1’s foot has a blister to part of the little toe, which was getting better. On 8/9/2025, the nurse’s note stated there was no more bleeding on R1’s left food and it was slowly healing.

On 03/16/2026, the Department interviewed R1’s authorized representative (AR). AR stated R1 had a wound on the left foot, but it was not a pressure injury. AR stated R1 was diagnosed with a clubfoot which caused R1 to drag the foot while walking. AR is aware home health nurses visit R1 at the facility once a week to treat the wounds. AR stated R1 received adequate care at the facility.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20250815163726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MASTEN CARE HOME	FACILITY NUMBER: 435202100
	VISIT DATE: 05/22/2026

NARRATIVE

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On 03/17/2026, the Department interviewed San Andreas Regional Center (SARC) (CD) Representative who was aware of R1’s wounds. SARC CD stated R1’s wound on left foot was due to R1 scraping the floor when R1 dragged the lower part of body. SARC CD stated facility staff cannot stop R1 from scooting on the floor due to residents’ personal rights. SARC CD stated an exception request was approved by the Department for R1 to continue to live at the facility with support of a licensed home health agency.

Based on review of R1’s Physician’s Report dated 09/18/2024, R1 has left spastic hemiparesis and has a left “clubfoot” and uses a wheelchair to ambulate. R1 is able to independently transfer to and from bed. Based on review of R1’s Appraisal/Needs and Services dated 09/10/2024, R1 is visited by home health nurse every week to monitor R1’s skin integrity. Based on R1’s SARC Individual Program Plan (IPP) dated 9/26/2024, R1 has Congenital Talipes Equinovarus (CTEV) or a “clubfoot” on R1’s left foot which affects the gait and R1 is to be seen by home health nurse weekly to monitor skin condition. Based on R1’s Functional Capability Assessment dated 05/13/2026, R1 is able to transfer in and out of bed or chair, reposition and move wheelchair themselves, R1 is able to walk well alone or with support.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator, Jhanelle Guico and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC9099 (FAS) - (06/04)

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