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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201054
Report Date: 02/03/2026
Date Signed: 02/03/2026 12:13:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/28/2026 and conducted by Evaluator Yasamin Brown
COMPLAINT CONTROL NUMBER: 15-AS-20260128135521
FACILITY NAME:MORI MANORFACILITY NUMBER:
019201054
ADMINISTRATOR:ALATORRE, MARIANOFACILITY TYPE:
740
ADDRESS:1476 164TH AVENUETELEPHONE:
(510) 600-3840
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:14CENSUS: 11DATE:
02/03/2026
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria Manjarez, Care Staff TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff at the facility are not monitoring resident's blood pressure
INVESTIGATION FINDINGS:
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On 2/3/2026 at 9:45 AM, Licensing Program Analyst (LPA) Y. Brown arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Care staff Maria Manjarez.

During the complaint visit, LPA reviewed the LIC 500 (Personnel report) and LIC9020 (client roster), interviewed the RP, S1, R1, and reviewed R1's record.

Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
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 2
Control Number 15-AS-20260128135521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MORI MANOR
FACILITY NUMBER: 019201054
VISIT DATE: 02/03/2026
NARRATIVE
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Continued from LIC9099.

Allegation: Staff at the facility are not monitoring resident's blood pressure
Finding: Unsubstantiated

Interview with the reporting party (RP) revealed that the facility has not been monitoring R1's blood pressure (BP). Interview with S1 revealed that R1 has not requested for the staff to check their BP and they have not received a doctors order stating that it is required to monitor R1s BP. Interview with R1 revealed that they have not requested the staff to monitor their BP but would prefer staff to do it. LPA reviewed R1's medication list and doctor's orders and there were no instructions that BP has to be monitored and checked.

Based on interviews and record review during visit, the allegation that staff at the facility are not monitoring resident's blood pressure was found to be unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiency cited.

Administrator gave authorization for Maria to sign today's report.



Exit Interview conducted with Maria and copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Yasamin Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2