Westborough Manor 6

On August 22, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrators, Anthony Diaz and Bella Terciano and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a single story facility. There are six resident rooms; all of which are private resident rooms. Resident rooms were observed to be clean with all required furniture. There is one staff room. Two full bathrooms were observed to be clean, odor-free and in good repair. Water temperature throughout the facility measured between 108-114 degrees F. Extra linen was observed to be present. First aid kit was observed to be complete. Dining room was observed free from tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed two day perishables, however did not observe seven day non-perishables. Medications and chemicals were observed locked an inaccessible to residents in care. Sharps were observed unlocked and accessible to residents. Sharps were immediately locked by caregiver. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of July 2024. LPA reviewed 5 resident records and 5 staff records. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Administrator and a copy is provided.

On November 6, 2024, Licensing Program Analyst (LPA), Murial Han conducted an case management visit to follow up on a case management visit on 10/23/2024. LPA met with caregiver, Linda Mondejar who called the administrator/licensee Anthony Diaz and explained the purpose of today's visit. During the case management visit on 10/23/2024, LPA issued a deficiency under Health and Safety Code 1569.605 as the facility did not have a copy of the current Liability Insurance and the plan of correction was due on 10/25/2024. On 10/28/2024 at 10:54am, the facility Licensees submitted a copy of a one page Worker’s Compensation and Employer’s Liability Insurance from the Berkshire Hathaway Guard Insurance Companies and initially LPA observed the facility was not listed under named insured. LPA informed the Licensees of the observation, and a few hours later at 1:16PM, the Licensee submitted an addendum of 2 more pages including the name insured- Westborough Manor on the 2nd page and facility's address on the 3rd page. After viewing the insurance policy, LPA proceed with calling the insurance company and the insurance retailer (Board Spectrum Insurance) for verification and they confirmed that this policy was for Worker's Compensation and it did not cover for General Liability Insurance and that the policy was terminated in 2018-2019 due to non-payment. In addition, they stated that when the policy was active, it did not include this facility and they did not know how the facility’s address appeared on policy. 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 Based on observation and record review, the administrator/licensees provided a copy of the expired worker’s compensation insurance policy and not the general liability insurance and the policy was altered as the insurance company confirmed that this facility was not included on the policy yet it appeared on the policy that was provided by the licensees. In addition, the administrator did not conform to the laws, rules, and regulations as the administrator did not ensure the facility has an active Liability Insurance Policy. Deficient is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with the caregiver and administrator/licensee over the phone. A copy of this report and the Appeal Rights are provided.

On August 21, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with caregiver, Linda Mondejar and explained the purpose of today's visit. The Licensees, Anthony and Sheila Diaz arrived and assisted with the inspection. Upon entrance, LPA observed PPE supplies and disinfectants on the floor by some of the resident's rooms and the facility staff stated that a few residents tested positive for COVID-19. According to the Licensees, this was not reported to CCL and Local Public Health. LPA toured the facility inside out and inspected the living room, dining area, kitchen, bedrooms, bathrooms, and backyard. The outdoor passageways were cleared. The facility has 6 residents and all of them are in private rooms. Furniture and furnishings were observed to be sufficient. Food supplies were sufficient of 2- days perishables and 7- days of non-perishables. Toilet, hand washing and bathing areas were observed clean and in operating condition. Comfortable temperature is maintained and lighting is sufficient for comfort. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. Central storage for medications, sharps and chemicals were observed to be locked and inaccessible to residents in care. 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 Hot water temperature in the kitchen and bathroom were measured at 111-114 degrees Fahrenheit. Fire extinguishers were checked. During tour of the garage, LPA observed a mattress, a medication bottle, a toaster, etc and staff stated that it is an area for staff to take breaks. A review of (6) resident files was conducted and noted on the LIC 858. A review of (3) staff files was conducted and noted on the LIC 859. The following documents were requested submitted to CCL by 8/22/24: - Liability Insurance, Administrator Certification and LIC 500 Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. . This report is reviewed and discussed with the Licensees. A copy of this report and the appeal rights were provided.

On September 12, 2023 at 1:15 p.m, San Bruno Regional Office conducted an office meeting with Licensee, Anthony and Sheila Diaz to discuss the findings from an audit that was completed by CCL Audit Section. Present in the meeting was Regional Manager, Vivien Helbling, Licensing Program Manager, Jackie Jin, Licensing Program Analyst, Murial Han and Auditor, Jacqueline Juarez joined virtually. The Department has requested an audit to be completed by the CCL Audit Section to ensure that the facility has sufficient funds to continue operations as the sister facility that was operated by the same owner was closed due to non-payment of rent. Based on the audit result, the licensee does not have a sound financial plan, has negative equity and is not generating enough income to meet its expenses. Licensee to ensure their corporate statues is reinstated and obligation with Franchise Tax Board (FTB) are paid. Licensee should work to reduce payroll cost, as payroll is absorbing all income earned. With paying savings, Licensee to increase food expenses and become current with all utilities. During today's meeting, the following findings and the violations were reviewed with the licensee: finding #1 Finances, the audit revealed that the Licensee is not making sufficient income to meet operating expenses; finding #2 Accountability of Licensing Governing Body, the audit revealed that the licensee did not pay operational expenses timely; finding #3, General Food Service Required, the audit revealed that the facility did not spend sufficient funds on food for 5 residents based on the USDA guidelines for male and female ages 51-70 and 71+; finding #4, Administrator Qualification, the audit revealed that the administrator did not ensure operating expenses were paid on time, and residents were supplied with sufficient food according to the USDA guidelines. 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 Based on the audit findings and to ensure facility will be in compliance with Title 22 regulation, facility will comply with quarterly Financial Monitoring for a period of one year or until it is evident that the licensee has an adequate financial plan in place. The first due date being October 31, 2023 (July, August, and September 2023) documents are to include LIC 401, for the month of September 2023; bank statements for July- September 2023; utility bills, cable/phone bills and food receipts for the month of September 2023. Deficiency is cited for the above violations on LIC 809D. This report is reviewed and discussed with the licensee. A copy this report and appeal rights are provided.