Fil-Am Home for Seniors II

Type of visit: POC

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced Plan of Correction (POC) Case Management visit to address deficiencies related to the facility’s failure to correct previously cited deficiencies. LPA was greeted by Kevin Baas, Lead Caregiver and discussed the purpose of the visit. LPA spoke with Licensee Toby Miclat via phone in detail. On January 15, 2026, LPA conducted a Case Management visit to follow up on deficiencies cited during the Annual Inspection, for which a Plan of Correction (POC) was due by December 23, 2025. During that visit, the deficiencies remained uncorrected, and the deficiencies were re-issued with a new POC due date of January 16, 2026. As of the date of this follow-up visit, the deficiencies remained uncorrected. The following deficiencies were cited: CCR 87411(f)- licensure. A report shall be made of each screening signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. (continued on 809C) Plan of Correction The licensee agrees to ensure all staff obtain TB tests and physical examinations. Proof of completed TB tests and physical exams for all staff will be submitted by the POC date. (POC Corrected) HSC 1569.625(b)(2)- (2)In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. Plan of Correction Licensee is to ensure annual training requirements are met annually. Licensee will update training requirements and send proof by POC date. CCR87411(c)(1) -(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Plan of Correction Licensee to ensure staff receive first aid training as per regulation. Licensee to submit proof of first aid training for staff by POC date. (continued on 809C) CCR87465(e) -(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. Plan of Correction Licensee to obtain a physician’s order for Imodium and Claritin (allergy medication) or discontinue medications and submit by POC due date. Licensee to continue to review PRN policy with residents’ families. CCR87633(a)(1)- (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. Plan of Correction Licensee to ensure they are following their approved hospice waiver. Licensee to submit a request for a hospice waiver increase. CCR87463(a)- (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. Plan of Correction Licensee to ensure they are updating appraisals as frequently as necessary or once every twelve months. Licensee to submit updated re-appraisals by POC date. (Continued on 809C) CCR87458(c)(1)(A)- (c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. Plan of Correction Licensee is to ensure compliance on Communicable Tuberculosis examinations prior to acceptance of a resident. Licensee is to submit proof of TB text by POC date. Civil penalties will be issued during today’s visit for the assessed dates of January 17 through January 20, 2026. Failure to correct the deficiencies may result in additional civil penalties. An exit interview was conducted with Kevin Baas, Lead Caregiver. Civil penalties were provided for the assessed period of January 17 through January 20, 2026, please refer to LIC 421. A copy of this report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced Case Management visit to address deficiencies related to the failure to correct cited deficiencies. LPA was greeted by Kevin Ortiz, Lead Caregiver and discussed the purpose of the visit. On December 2, 2025, Licensing Program Analyst (LPA) Gabriela Castro conducted an Annual Inspection and cited deficiencies with a Plan of Correction (POC) due by December 23, 2025. As of the date of the follow-up visit, the deficiencies remained uncorrected. The following deficiencies were cited: CCR-87411(f)- A report shall be made of each screening signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. Plan of Correction The licensee agrees to ensure all staff obtain TB tests and physical examinations. Proof of completed TB tests and physical exams for all staff will be submitted by the POC date. (continued on 809C) HSC -1569.625(b)(2)- (2)In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. Plan of Correction Licensee is to ensure annual training requirements are met annually. Licensee will update training requirements and send proof by POC date. CCR-87411(c)(1) -(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Plan of Correction Licensee to ensure staff receive first aid training as per regulation. Licensee to submit proof of first aid training for staff by POC date. CCR-87465(e) -(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. Plan of Correction Licensee to obtain a physician’s order for Imodium and Claritin (allergy medication) or discontinue medications and submit by POC due date. Licensee to continue to review PRN policy with residents’ families. CCR-87633(a)(1)- (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. Plan of Correction Licensee to ensure they are following their approved hospice waiver. Licensee to submit a request for a hospice waiver increase. (continued on 809C) CCR-87463(a)- (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. Plan of Correction Licensee to ensure they are updating appraisals as frequently as necessary or once every twelve months. Licensee to submit updated re-appraisals by POC date. CCR-87458(c)(1)(A)- (c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. Plan of Correction Licensee is to ensure compliance on Communicable Tuberculosis examinations prior to acceptance of a resident. Licensee is to submit proof of TB text by POC date. An exit interview was conducted with Kevin Ortiz, Lead Caregiver. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.the state’s words, verbatim · CDSS document, Jan 15, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Jan 16, 2026

All personnel, including the licensee and administrator, shall be in good health, and physically capable of performing assigned tasks .... shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician This requiment is not met as evidenced by: Based on record review, the licensee did not comply with the cited section. Three (3) of four (4) staff files lacked TB test results and/or physical examinations, posing a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: The licensee agrees to ensure all staff obtain TB tests and physical examinations. Proof of completed TB tests and physical exams for all staff will be submitted by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(2) · Plan of correction due date: Jan 16, 2026

2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports... This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requiment is not met as evidenced by: Based on record review, the licensee did not comply with the cited section, as three (3) of four (4) staff files lacked required ongoing training documentation, posing a potential health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Licensee is to ensure annual training requirements are met annually. Licensee will update training requirements and send of proof of training by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c)(1) · Plan of correction due date: Jan 16, 2026

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training... (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the cited section, as one (1) of four (4) staff lacked proof of first aid certification, posing a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Licensee to ensure staff receive first aid training as per regulation. Licensee to submit proof of first aid training for staff by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(e) · Plan of correction due date: Jan 16, 2026

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the cited section, as two (2) of four (4) residents had over-the-counter medications without physician orders, posing a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Licensee to obtain a physician’s order for Imodium and Claritin (allergy medication) or discontinue medications and submit by POC due date. Licensee to continue to review PRN policy with residents’ families.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(1) · Plan of correction due date: Jan 16, 2026

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician... who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services... (1) The licensee has received a hospice care waiver from the department. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the cited section, facility exceeded its hospice waiver capacity (2 approved; 4 on hospice), posing a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Licensee to ensure they are following their approved hospice waiver. Licensee to submit a request for a hospice waiver increase.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Jan 16, 2026

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition.. keep the appraisal accurate. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above in six (6) out of six (6) residents did not have updated re-appraisals which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Licensee to ensure they are updating appraisals as frequently as necessary or once every twelve months. Licensee to submit updated re-appraisals by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(c)(1)(A) · Plan of correction due date: Jan 16, 2026

c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results.. (A) Communicable tuberculosis. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above in six (6) out of six (6) residents did not have TB test on file which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Licensee is to ensure compliance on Communicable Tuberculosis examinations prior to acceptance of a resident. Licensee is to submit proof of TB test by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Maria Heidi Baquiran and explained the reason for the visit. Max Raharuhi, Administrator Assistant arrived shortly thereafter. The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is five (5) non-ambulatory residents and one (1) bedridden only. This facility may retain no more than two (2) hospice residents. There were four (4) residents under hospice care during inspection. Facility Tour & Observations Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Physical Plant The facility is in a residential area and is a one-story home consisting of five (5) resident bedrooms, one (1) restrooms, living room, kitchen, dining area, laundry room, garage, front yard, and backyard. LPA observed five (5) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). Cleaning supplies and toxic substances were accessible to residents in a kitchen cabinet under sink. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats; hot water measured in bathroom (1) 115.2°F which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. **Continued on LIC809C** Smoke/carbon monoxide detectors were functional; fire extinguisher was located by the front entrance. There were no bodies of water present. Backyard provided shaded seating. Passageways and exits were observed to be clear and unobstructed. Food Service Refrigerators/freezers were maintained at proper temperatures (refrigerators maximum of 40 degrees °F and freezer 0-degree °C) with sufficient supply of 2-day perishable and 7 days non-perishable food. Fresh produce, proteins, and dry goods were stocked. Knives and were observed in a locked kitchen drawer. Health-Related Services & Records Six (6) resident files were reviewed. Files contained Admissions Agreements, Pre-Placement Appraisals, Consents and Rights Acknowledgments. However, TB test results were missing from the files reviewed, which does not meet Title 22 record keeping requirements. Four (4) residents’ medications were reviewed and two (2) out of four (4) residents had unprescribed PRN’s; medications were observed to be centrally stored in a locked hallway closet. MAR logs were observed to be current. Disaster Preparedness Last fire/earthquake drill was conducted on October 19, 2025, with logs available. LIC 610D Emergency Disaster Plan was posted on kitchen bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated. Personnel Records & Training Four (4) files were reviewed and included criminal record clearances, two (2) out of four (4) files did not have updated CPR/First Aid training, required annual trainings and three (3) out of (4) did not have TB screenings. Insurance Liability insurance was in compliance with an expiration date of April 5, 2026. An exit interview was conducted with Kevin Ortiz Lead Caregiver. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. Kevin Ortiz Lead Caregiver was advised of the nature of the deficiency, the regulatory basis, and the required Plan of Correction (POC). Mr. Ortiz agreed to submit proof of corrections by the POC due dates specified. A copy of this report, LIC 809D/809C, and appeal rights will be provided via email.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit on 1/28/2025 and was greeted by Caregiver Maria Heidie Baquiran. Co-Administrator Lea Loaiza arrived shortly after. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected five (5) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip mat in showers. Shower was observed to be wheelchair accessible. Facility has video surveillance inside common areas only. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 10/11/2024. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. See 809-C Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Staffing: Administrator Certificate for Toby Miclat expires 10/12/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the four (4) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for four (4) out of the four (4) personnel records reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for five (5) non-ambulatory of which one (1) may be bedridden. This facility may retain no more than two (2) hospice residents. There were two (2) residents under hospice care during inspection. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during visit. Exit interview conducted. A copy of this report, and LIC 9102 was provided.the state’s words, verbatim · CDSS document, Jan 28, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 11/30/2023. LPA was met by Caregiver Rodrigo Celesios and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which five (5) may be non-ambulatory. LPA OBSERVATIONS: The facility is a single-story dwelling located in a residential neighborhood and consist of five (5) resident bedrooms, one (1) staff bedroom, one (1) resident bathroom, one (1) staff bathroom, kitchen, dining room, living room, front yard, and backyard. Front Yard: Front yard is well maintained, and no hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. Kitchen sink water temperature was measured at 119.3 degree F. LPA Ramirez observed chemicals and cleaning solutions, located in under kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room/: Dining room was observed to contain one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed nearby thermostat in this area to read 79 degree F. Linen Closet: Contained plenty linens, towels, and hygiene products See 809-C Resident Rooms 1 - 5: LPA Ramirez inspected five (5) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. LPA Ramirez observed proper signage indicating the use of oxygen in two (2) out of the five (5) bedrooms. LPA Ramirez medications prescribed for R2 in two different trays on top of R2’s nightstand. Per record review, R2 may not administer medication or store medication. Bathroom: Water temperature in bathroom was within 105-120 degree F. LPA observed non-slip mats in shower and grab bars near toilet. Backyard: No hazards were observed. Plenty of shade and seating was observed. Centrally Stored Medications: Medications were observed to be stored in facility hallway closet and inaccessible to five (5) out of five (5) residents in care. Emergency Drills: Staff could not provide documented proof if emergency drills conducted. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for five (5) staff. Documented proof of required annual training was not observed. Resident Files: Five (5) resident files were reviewed. LPA did not observe required annual physician’s report for R2. Liability Insurance & Infection Control Plan: Licensee could not furnish proof of liability insurance during visit. LPA Ramirez observed updated infection control plan. Deficiencies and technical advisories are being cited. A copy of this report, 809-D, LIC 9120 and appeals rights was provided.the state’s words, verbatim · CDSS document, Nov 30, 2023

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.