Magnolia of Millbrae

On 4/6/2026, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator, Assistant Executive Director Charito Amoranto. LPA explained the purpose of the visit. The facility is licensed for age range 60 and over. All may be non-ambulatory. License is approved up to 9 hospice residents. LPA toured the facility and a random sample of resident rooms, common areas, activity areas and kitchen area. LPA observed some residents were at different activity rooms. All apartments have emergency pull cords in the bedroom and restrooms. The facility swimming pool is secured. Hot water was also tested in the resident rooms and the temperature was at 110 deg F. Facility has evacuation chairs on stair wells. Facility has sprinkler system. All fire extinguishers have been checked and current. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid floors. There is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Emergency drills are done every month. Six resident records and six staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA received the following documents: Certificate of Liability Insurance, LIC610E & LIC500. No deficiencies are cited at this time. Report is reviewed and a copy is provided.

On 09/23/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an uannounced case management visit in order to deliver findings regarding the allegation received. LPA met with both Administrator - Lola Borego and Assistant Executive Director - R.N. Charito Amoranto and explained the purpose of today's visit. LPA Vado conducted a case management visit to discuss the incident report received on 09/22/2025 regarding bed bugs in the facility. The bedbugs are isolated to only one room. The resident has been moved to another room and all the resident's clothing and personal belongings are treated and moved along with the resident to the new room. The resident's room is being treated by a commercial pest control company. Findings so far show no spread of the bugs to any other units. Resident will be moved back after the room has been cleared by pest control of any more bugs. No citations issued. Report is reviewed with Administrator - Lola Borego and Assistant Executive Director - R.N. Charito Amoranto and a copy is provided on this day.

On 4/11/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unannounced Case Management visit to deliver an immediate exclusionary letter for S1. LPA was greeted by Charito Amoranto, Assistant Executive Director and explained the purpose of the visit. An exit interview was conducted. A copy of the report along with the immediate exclusionary letter was left at the facility.

On 03/11/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - annual continuation visit. LPA met with assistant executive director Charito Amoranto and explained the purpose of today's visit. During today's visit LPA reviewed resident files at random and reviewed medications for residents. Per observations made files are current and medications are current as well. No citations issued on this day. LPA reviewed this report with Charioto Amoranto and provided a copy of this report.

On 03/06/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year inspection. LPA met with the administrator Lola Borrego and explained the purpose of today's visit. The facility is licensed for age range 60 and over. All may be non-ambulatory. License is approved up to 9 hospice residents. 4 are currently on hospice at this time. This is a 5 story facility. The ground floor primarily consists of the dining room, kitchen, game room, hair salon, exercise room, pool, whirlpool, library arts and crafts room, and library. Facility emergency food supply is located also on the ground floor in a large storage room Emergency water is available as well. Facility is equipped with diesel powered emergency backup generator as well also located on the ground floor in an outside area. Floors 1 through 4 are resident living units. Resident population is mixed with assisted living and independent living residents. The facility does not have any dementia residents. Residents rooms on each floor consists of 1 or 2 bedroom apartments. 4 apartments are inspected. All apartments in the facility contains a kitchen, full bathroom, and stacked washer and dryer. Apartments 140, 221, 331, and 409 had water temperature measured. All temperatures recorded between 107F to 120F. All apartments have emergency pull cords in the bedroom and restrooms. Facility does have a pendant call system for those residents that wish to have them. Each apartment also has its own thermostat for residents to use to heat their apartment. There are 2 enclosed courtyards observed and both are in good repair with tables and chairs. The facility swimming pool is secured and residents are required to be buzzed into the swimming area. Cameras are posted in common areas through out the facility. Emergency routes are free and clear of any obstructions. On the fourth floor of all stairwells there are stair chairs in the event of an emergency. Carbon monoxide detectors are installed in all apartments including smoke detectors and fire sprinklers. Fire extinguishers are observed through out the facility with inspection tags dated 10/23/2024. The facility is fully equipped with fire sprinklers through out. Facility conducts emergency drills monthly. Last drill conducted is logged on 02/18/2025. Continued on next page... 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 Page 2 Kitchen is observed to be fully stocked with 2 day fresh food supply and fully stocked freezer. Emergency food supplies are in place. Ansul and hood system are clean and serviced regularly. All kitchen appliances and washing machines are functioning. Laundry room is observed on the ground floor to be fully operational, clean, and organized. Medications, medical kit, and sharps are stored in locked medication room on 1st floor not accessible to residents. temperature is maintained, passageways are clear, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hygiene supplies are in place. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. LPA reviewed staff files on this day which appear to be current. Staff training records are observed to be current and in place. Administrator certificate for Lola Borrego is observed as current expiring 05/12/2026. Inspection will be completed at a later date to review resident records and medications. The following updated forms are requested to be submitted to CCLD by 03/13/2025 : • Copy of updated Administrator Certificate • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or current lease Report is reviewed with administrator Lola Borrego and a copy is provided on this day.

To complete annual inspection of 4/12/24, LPA Jeung reviewed staff records--including training--and reviewed clients' admission agreements. In addition, medication discrepancies pertaining to supplements observed on 4/12/24 have been resolved for client #3. No deficiencies of the California Code of Regulations, Title 22 are observed. Facility is operating in substantial compliance.

LPA Audrey Jeung toured facility, which consists of 1 and 2 bedroom assisted living and independent living apartments on four floors of this 5- story community. Several apartments are inspected. All apartments have kitchen and washer and dryer. Common rooms--dining room, game room, hair salon, exercise room, pool, whirlpool, library arts and crafts room, library--are located on ground floor, where there are 2 enclosed courtyards. The pool is secured. There are no accessible bodies of water or fire safety hazards observed. Operable carbon monoxide detectors are installed in apartments. Medications and sharps are stored in locked medication room on 2nd floor--inaccessible to clients--a comfortable temperature is maintained, passageways are clear, and lighting is sufficient for comfort and safety. Hot water temperature checked at 107 degrees F in 2nd floor room. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material and hygiene supplies are maintained. Food supply and first-aid kit are inspected. Emergency signal system is installed in each apartment--in bedroom and bathroom--and transmits visual and audible signal to reception desk as well as 4 administrative offices. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Food service staff have current safe food handling certifications, including food and beverage director and executive chef. Quarterly reviews are completed by a registered dietician and reports are maintained; copies of last 2 reports are given to LPA. Lola Borrego and Charito Amoranto are certified RCFE administrators (x 5/24 and (10/24) that oversee facility operations. Some client files and medications records are reviewed. Staff records, including training, will be reviewed at a later date. Updated Emergency Disaster Plan (LIC610E) is provided to LPA. The following information is requested to be submitted to CCL by 4/26/24 - Facility sketch (floor plan) - Proof of current liability insurance (including coverage limits) - LIC 309 Administrative Organization No deficiencies are cited today. Annual inspection to be completed at a later date.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 10/7/23 at 10:30AM. LPA met with Lola Borrego , Administrator and stated the purpose of the visit. The facility is licensed for a capacity of 180 non-ambulatory residents of which 9 may receive hospice care services. There are 4 residents receiving hospice services at this time. The Administrator Certificate was observed for Lola Borrego which expires 5/12/24. LPA observed residents and conversed with them during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. The most recent emergency drill was conducted 9/11 /23. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 72.3*F which is within the required range of 68-85*F. The hot water temperature was measured at 114.4*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), pull alarm system, smoke and carbon monoxide detectors in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed 3 staff files and 3 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Any Addendums to the Infection Control Plan, Designation of Facility Responsibility (LIC308), Personnel Report (LIC500) to include the Administrator presence in the facility, Administrator Certificate-Updated, Emergency Disaster Plan (LIC610E), and Liability Insurance. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted, a copy of the report was given.