Illustration — no photo of this home on file yet

Fil-Am Home for Seniors III

Small home·Licensed for 6·Claremont, California

Licensed since 2020Licence #198603218Medi-Cal ALW
  • Care approvals on fileWheelchair · Dementia · HospiceState licensing record · September 13, 2026
  • Estimated starting rate$4,550 a monthCovelight estimate · likely $3,700–$5,600
  • Home sizeLicensed for 6Small care home · a licensed care home (RCFE)
  • Room at the last state visit6 of 6 beds occupiedApril 30, 2024 · not a current opening
  • Ways to payMedi-Cal ALW acceptedDHCS participant list · September 23, 2026
  • Last state visitAugust 13, 2026CDSS inspection record
  • Licence holderStateside Medical LLCSince 2020 · 3 licensed homes

Fil-Am Home for Seniors III is a small care home in Claremont — a licensed residential care facility for the elderly (RCFE), the licence category behind “assisted living” and “board and care.” It is licensed for 6 residents since 2020. Bedridden care is not on file.

Built from CDSS public records · September 13, 2026. Every fact below names its source and date.

Quick answers and the state record

A citation does not make a home unsafe, and an empty file does not make a home good.

Quick answers about Fil-Am Home for Seniors III

Is Fil-Am Home for Seniors III licensed?

The state lists this license as “Licensed,” per CDSS records as of September 13, 2026.

How many residents is Fil-Am Home for Seniors III licensed for?

6 residents — a small home, per CDSS records as of September 13, 2026.

Has Fil-Am Home for Seniors III been cited?

2 Type A and 6 Type B citations since 2020, per CDSS records as of September 13, 2026. Those records count 14 state visits over the same years.

Is Fil-Am Home for Seniors III still open?

This license was on the CDSS roster as of September 28, 2026.

What does Fil-Am Home for Seniors III cost?

$4,550 a month to start is a Covelight estimate, likely $3,700–$5,600. This home’s own rate is not on file. Ask: “What is the all-in monthly rate, and what would push it higher?”

Covelight’s estimate starts from the rates 9 small homes and similar homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

Among 5 other homes of a similar licensed size in Claremont that publish a starting rate, the middle half runs $2,388 to $4,800 a month, and the middle figure is $4,500 (n = 5 other homes publishing a starting rate).

Each of those is a home’s own published figure, gathered on its own date in September 2026 — not an average of ours, and not a survey. Similar size means small and mid-size homes counted together, and large communities counted on their own, because they are different markets.

A home outside the band is not overcharging or underpricing: a starting rate covers different things in different homes, which is the first thing to ask about.

The price is made in the phone call. Nothing here is a quote, an offer or a discount.

A starting rate is the room and the base care. California homes commonly bill care levels, medication management, supplies, transport and a second person in the room as extras. Many also charge a one-time fee at move-in. Ask for that list in writing before anything is signed.

Only prices a home put out itself count here: its own website, a listing it supplied, or a price a listing site says the home confirmed. Prices a site shows without saying where they came from are left out. What Medi-Cal’s Assisted Living Waiver covers in a care home.

Does Fil-Am Home for Seniors III take Medi-Cal?

On Medi-Cal’s Assisted Living Waiver: this home appears on the DHCS participation list, September 23, 2026. Confirm eligibility and current participation with the program. The waiver pays for care services, not room and board.

Who holds the license?

The license is held by Stateside Medical LLC, per CDSS records as of September 13, 2026. See the homes licensed to Stateside Medical LLC — at least 3 on the state roster.

Is there a hospital nearby?

Casa Colina Hospital is 2.3 miles away in a straight line, per the CDPH licensed-hospital list dated September 16, 2026. See licensed care homes near it.

Can Fil-Am Home for Seniors III keep a resident on hospice?

Hospice care is approved on this license, per CDSS records as of September 13, 2026.

Fil-Am Home for Seniors III license and inspection record

  • Name on the license: “FIL-AM HOME FOR SENIORS III”, per the CDSS roster as of May 25, 2025.
  • License #198603218. The state lists this license as “Licensed,” per CDSS records as of September 13, 2026.
  • Licensed for 6 residents — a small home, per CDSS records as of September 13, 2026.
  • Licensed to Stateside Medical LLC, per CDSS records as of September 13, 2026.
  • First licensed in 2020, per CDSS records as of September 13, 2026.
  • 14 state inspection visits since 2020, per CDSS records as of September 13, 2026.
  • 2 Type A and 6 Type B citations on file since 2020, per CDSS records as of September 13, 2026. The same records count 14 state visits in that period.
  • 3 complaints and 5 substantiated allegations on file since 2020, per CDSS records as of September 13, 2026. One complaint can carry several allegations.
  • The most recent state visit on file is August 13, 2026, per CDSS records as of September 13, 2026.
Type A citationa violation that poses an immediate risk to health, safety or personal rights if it is not correctedType B citationa violation that could become a risk if not corrected, or one involving records, resources or required services

California writes these definitions for every licensed home, not for this one. CDSS citation definitions (PDF) ↗

See the state’s own record

Can they support the care needed?

California licenses a home for specific kinds of care. The state’s record lists what this home is approved for; the home’s own answers fill in what changes as needs change.

  • Wheelchair / non-ambulatoryApproved · covers up to 6 residents
  • Dementia / memory careApproved by the state
  • Hospice careApproved by the state
  • BedriddenNot on file · ask the home

State licensing record · September 13, 2026. An approval may cover specific rooms or residents; it does not establish an opening.

Read the state’s own wording
AGE RANGE 60 AND OVER. APPROVED FOR 6 NON AMBULATORY. HOSPICE WAIVER APPROVED FOR 2 RESIDENTS.

983 - RCFE / DEMENTIA

CDSS record, verbatim · September 13, 2026

As needs change

  • Staying through hospice

    Hospice waiver on file — care may continue at the end of life

    Ask: “If hospice is needed, can care continue here until the end?”

    State licensing record · September 13, 2026

  • If memory loss develops

    Dementia-care designation on file

    Ask: “Can we read the dementia care disclosure and discuss how daily support works?”

    State licensing record · September 13, 2026

3 more questions to ask the home
  • Two-person transfers or a lift

    Not on file

    Ask: “If two people or a lift are needed to transfer, can the person stay?”

  • Someone awake overnight

    Not on file

    Ask: “Who is awake overnight, and how do residents ask for help?”

  • Medicines

    Not on file

    Ask: “Who manages the medicines, and what happens when a dose is missed?”

What it costs here

Covelight estimate

$4,550a month to start

Likely $3,700–$5,600

From 9 nearby homes that publish rates · this home’s rate is not on file

Likely monthly total

$4,550a month

Likely $3,700–$5,800

With a shared room and basic help.

An estimate for planning, not a quote. The price is made in the phone call.

See the full cost breakdownRoom, care and fees · how people pay · how this estimate works
Room
Daily care
Sharing the room
  • Starting monthly rate$4,550likely $3,700–$5,600

    Covelight’s estimate starts from the rates 9 small homes and similar homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

  • Basic help with daily careUsually includedup to $600

    Basic help is usually part of the starting rate. Homes that price care by level start around $600 a month (45 California homes publish a care-level range, seen in September 2026).

  • One-time move-in fee$2,000one time · likely $0–$4,000

    Homes that list a one-time entry or community fee charge a median of $2,000 (134 California listings; middle half $1,000–$4,000). Many homes list none — ask.

Likely monthly totalLikely $3,700–$5,800
$4,550
First monthWith a one-time move-in fee · likely $4,350–$8,900
$6,550
How people payOn the Medi-Cal waiver list · private pay, SSI/SSP, veterans, insurance
  • Private payMost residents pay from savings, a home sale or family help. Ask for the rate and what it includes in writing.
  • Medi-Cal Assisted Living WaiverThis home appears on the DHCS participation list, September 23, 2026. Confirm eligibility and current participation with the program. The waiver pays for care services, not room and board. For a resident on SSI/SSP, California’s 2026 standard sends $1,444.07 a month to the home for room and board.
  • SSI/SSPCalifornia’s 2026 standard is $1,626.07 a month; $1,444.07 of it goes to the home and $182 stays with the resident. Whether this home accepts it is not on file — ask.
  • VeteransVA Aid & Attendance can add to a veteran’s or surviving spouse’s pension. Ask whether residents here have used it.
  • Long-term care insuranceMost policies pay for licensed care homes. Ask what paperwork the home provides for claims.
  • MedicareDoes not pay for room and board in a care home. It can still cover hospice or home-health visits inside one.
If the money runs out, what Medi-Cal covers
Avoid surprises on the billWhat changes the price, and what to ask
  • The care level

    Some homes charge one all-inclusive rate. Others add levels or points as needs grow. Ask how the level is set, who decides, and what the next level costs.

  • What is billed separately

    Medication management, incontinence supplies, transportation and a second person in the room are often extra. Ask for the list in writing.

  • Move-in costs

    A one-time community fee or deposit is common. Ask what it covers and whether any of it comes back if the stay is short.

  • Increases

    California requires at least 90 days’ written notice, with reasons, before a rate rises (Health & Safety Code §1569.655). A change in the resident’s care level is the section’s own exception and can be billed sooner.

  • What is the full monthly cost for the room and care we need, and what does it include?
  • What would the next care level cost, and who decides when it changes?
  • What is billed separately, and is there a one-time fee or deposit at move-in?
  • Is any private-pay period required before another payment program can begin?
How this estimate worksWithin 25% for 7 in 10 homes in testing

Covelight’s estimate starts from the rates 9 small homes and similar homes within 3 miles publish, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices. In testing, the likely range held the real rate for 6 in 10 homes. This home’s own rate is not on file.

9 homes like this within 3 miles publish starting rates mostly between $2,500–$4,800.

  • Only prices a home put out itself count: its own website, a listing it supplied, or a price Seniorly says the home confirmed. Prices a listing site shows without saying where they came from are left out.
  • Nearby homes are the nearest of the same size that publish a rate, widening from 3 to 40 miles until at least 8 do. The estimate starts from what they charge, then adjusts for this home’s size, state care approvals, Medi-Cal waiver participation, years licensed and the area’s prices.
  • Room, care-level, second-person and move-in lines come from what California homes publish on listing sites. Memory care uses Covelight’s researched premium over assisted living.
  • Totals add each line’s figure and combine the lines’ ranges as separate charges, because a home is rarely at the top, or the bottom, of every line at once.
  • We tested this estimate on 1,546 California homes that publish their own starting rate. It was within 10% of the real rate for 3 in 10 homes and within 25% for 7 in 10; the likely range held the real rate for 6 in 10 (September 12, 2026).
  • It cannot see this home’s specials, how it assesses care, or which rooms are open.
Show the 9 nearby homes behind this estimate

Where it is

  • 380 W Baseline Rd, Claremont, CA 91711Address from the public record · September 13, 2026. Confirm the entrance with the home before visiting.

Opening the neighborhood map…

The state record

California inspects every licensed home and publishes what it found. Here are the dated documents and the state’s own words, beside what is typical for homes this size.

Since 2022, the state has filed 13 documents for this home, and its records count 14 visits since 2020. The most recent is a facility evaluation report, dated August 13, 2026.

On file since
2022
State visits
14
Most recent visit
August 13, 2026
Occupied · April 30, 2024 visit
6 of 6 bedsa count on that day, not an opening

We hold 4 complaint reports the state published for this home, dated March 16, 2022 to April 30, 2024. 4 of the 4 carry the state's recorded outcome word: “Substantiated” (3), “Unsubstantiated” (1). 4 include the transcribed allegation the state investigated, word for word. Summary composed by computer from the 4 complaint reports below — every count derives from them, and the documents themselves are the state's records, verbatim. We never grade, score, or color a record.

Beside homes the same size

  • Type A citations2typical 0
  • Type B citations6typical 0
  • Substantiated allegations5typical 0
  • Total complaints3typical 0

“Typical” is the statewide median across the 6,808 licensed small board-and-care homes (6 or fewer beds) in the state record — larger, longer-licensed homes accumulate more visits and reports, so compare like with like. One complaint can contain several allegations. Counts cover this licence since 2020.

Year by year
YearVisitsDocumentsSubstantiated20262202025110202434120232222022440

The last 36 months — 7 of 13 documents

20262 state visits · 2 documents
Aug 13, 2026Facility evaluation reportReport on file

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management-Deficiencies visit on 08/13/2026. LPA was met by House Manager Claudia Orozco and explained the purpose of the visit. Administrator Toby Miclat was notified via phone of LPA’s visit. During record review, LPA discovered that staff#1 (S1) and staff #2 (S2), who were present at the facility during LPA’s visit did not have proof of criminal clearance. Interview with S1 revealed that they are a volunteer and do not provide direct care and supervision to residents. S1 revealed that they began volunteering to assist with cooking and cleaning the facility only. S1 revealed that they do not have proof of criminal clearance and they began volunteering effective 08/06/2026 and only on Thursdays, Fridays and Saturdays. Interview with S2 revealed they provide direct care and supervision to residents. S2 revealed that they started working at the facility 3 weeks ago and they have not obtained criminal clearance. Based on interviews and records reviewed, LPA issued one (1) deficiency and two (2) civil penalties in the amounts of $500 & $400. Exit interview was conducted. A copy of this report, 809-D, LIC 421BG and appeals rights was provided.the state’s words, verbatim · CDSS document, Aug 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 14, 2026

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department This requirement was not met as evidenced by: S1 and S2 did not obtain a California clearance or exemption as required. This poses an immediate risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator Miclat will draft a plan on how future staff/and or volunteers will obtain criminal clearance or exemption prior to working or volunteering at the facility. Plan must be received by 08/14/2026, via email.

Jan 28, 2026Facility evaluation reportReport on file

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 Ana Aparicio and explained the reason for the visit. Maxson Raharuhi, Assistant Administrator arrived shortly thereafter. The facility is licensed to serve residents ages sixty (60) and older. The approved capacity is six (6) non-ambulatory residents. The facility is approved to retain no more than two (2) residents receiving hospice care. There were two (2) 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. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. 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 four (4) resident bedrooms, one (2) restroom one being a guest restroom, living room, kitchen, laundry room, dining area, laundry room, garage, front yard, and backyard. Property includes a caregiver corridor near bedroom four (4). LPA observed four (4) 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. (continued on 809C) 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) 113.2°F, bathroom (2) 111.5°F which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. Smoke/carbon monoxide detectors were functional; fire extinguisher mounted in the kitchen. 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 Five (5) residents files were reviewed and contained current required documents Admissions Agreements, Pre-Placement Appraisals, Consents, Needs/Service Plans, Physician’s Reports, ambulatory status and Rights acknowledgments. R1 and R2 were missing TB screenings. Five (5) residents’ medications were reviewed; medications were observed to be centrally stored in a locked cabinet in laundry room. It was observed that R1 and R3 require assistance from staff with administration of injectable medications. Additionally, R1 did not have Albuterol medication available. Disaster Preparedness Last fire/earthquake drill was conducted on January 27, 2026, with logs available. LIC 610D Emergency Disaster Plan was posted on front entry 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) staff files were reviewed and included criminal record clearances in all staff files. Current CPR/First Aid certificates were observed for S1-S3; however S4 certificate was expired, TB screenings documentation was present for S1-S3 however, no TB screening for S2 was observed. Required training was observed to be in files. Insurance Liability insurance was in compliance with an expiration date of April 4, 2026. An exit interview was conducted with Ana Aparicio, 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 were provided.the state’s words, verbatim · CDSS document, Jan 28, 2026
20251 state visit · 1 document
Feb 20, 2025Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by Caregiver Claudia Orozco. Administrators Toby Miclat and Lea Loaiza arrived shortly after. LPA Ramirez explained the purpose of the visit. The facility is located on a main 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. Carbon monoxide detectors and smoke alarms in hallways were tested and operational. 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 showers. LPA Ramirez observed no-slip mat in showers. Bathroom#2 has a wheelchair accessible shower. 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 01/02/2025. 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: Medications are centrally stored in locked kitchen cabinet and in bubble packs and/or original containers. The facility uses electronic charting to document medications administered and other charting notes on residents. 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 three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed. Infection Control: Staff is 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. LPA Ramirez observed staff wearing gloves while handling food. LPA Ramirez observed staff wearing gloves while proving care to a resident. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory. This facility may retain no more than two (2) hospice residents. There were 0 (zero) residents under hospice care during inspection. Resident Records/Incident Reports: LPA reviewed Resident files for six (6) residents in care. Resident files 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 this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Feb 20, 2025
20243 state visits · 4 documents
Apr 30, 2024Complaint investigation reportSubstantiated

Allegation investigated: Staff did not prevent resident from sustaining severe fractures while in care Staff did not prevent resident from sustaining pressure injuries

.Licensing Program Analyst (LPA) Alberto Lopez made subsequent visit today to deliver findings for complaint received on 12/02/2022. LPA met with Administrator Toby Miclat and discussed the purpose of the visit. During today’s visit, LPA took a tour of the facility, including random resident rooms, and common areas of the facility. On 12/05/2022, Licensing Program Analyst (LPA) Alberto Lopez made initial 10-day visit. During this visit LPA met with Acting Administrator Lea Loaiza and explained the purpose of today's visit. LPA conducted a tour of this facility. LPA did not observe any signs of neglect, or abuse, but did observe health and safety risks. LPA cited facility on Case Management report and 809D. LPA also reviewed files for three residents and obtained relevant documentation. (CONTINUED ON 9099C) Substantiated LPA obtained resident roster and names of staff. LPA asked facility for LIC500, and facility staff stated they would email it later today. LPA interviewed four staff (S#1- S#4), six residents (R#1-R#6) and two witnesses (W#1-W#2). Allegation: Staff did not prevent resident from sustaining severe fractures while in care. It is alleged that resident sustained fractures while in care due to facility Neglect/Lack of Care and Supervision. The investigation revealed: LPA Interviewed four (4) staff S1-S4 and four (4) of four (4) staff denied the allegations. LPA interviewed six (6) residents R1-R6 and six (6) of six (6) residents could not collaborate the allegation. Administrator denied that facility caused fractures, and three (3) of three (3) staff stated they were unaware that resident had facial fractures. According to Department interviews, and records reviewed, resident was admitted to facility on 05/01/2022. On 11/26/2022, resident was found to be lethargic and unresponsive. Facility called 911 and the resident was transported to Pomona Valley Hospital. At the hospital, evidence of facial fractures (Right orbital lateral wall fracture, right zygomatic arch fracture) was documented on hospital records for admission date of 11/26/2022. Based on supporting evidence, facility failed to provide proper medical attention, and the facility provided inadequate care and supervision that caused unexplained injuries while under care and supervision of the facility. There is sufficient evidence to substantiate this allegation. Allegation: Staff did not prevent resident from sustaining pressure injuries. It is alleged that staff did not prevent resident from sustaining pressure injuries while in care. The investigation revealed the following, LPA Interviewed four (4) staff S1-S4 and four (4) of four (4) staff denied the allegation. LPA interviewed six (6) residents R1-R6 and six (6) of six (6) residents could not collaborate the allegation. Administrator denied that resident developed pressure injury while at the facility. Administrator stated that resident arrived at facility with pressure injuries. (CONTINUED) According to Department interviews, and records reviewed, resident was admitted to facility from nursing home on 05/01/2022. Discharge paperwork from the nursing home documents a stage 1 pressure injury on each heel and sacrococcyx blanchable redness. Administrator agreed that resident arrived to the facility as described by the nursing home discharge paperwork. Resident was found to be lethargic and unresponsive on 11/26/2022. Facility called 911, and the resident was transported to Pomona Valley Hospital. While at the hospital, RN documented wound on resident’s buttock midline coccyx: 6cm x 6cm x 0cm (wound had no documented staging, photograph showed area to be redden, not open). RN also documented right foot wound with no documented staging. There was no mention of the left foot in the hospital records. Additional RN staff documented that resident had a “closed stage 3 pressure injury on coccyx and evidence of scar tissue”. Due to facility failing to provide proper care and supervision, resident’s pressure injury on coccyx progressed from blanchable redness to stage 3 during her stay at facility. There is sufficient evidence to substantiate this allegation. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, and Chapter 8 are cited on the attached LIC 9099D. An immediate $500 civil penalty is being issued during today's visit due to the neglect/lack of care and supervision resulting in resident sustaining fractures to face. An exit interview was conducted with the Administrator Toby Miclat and a hard copy of licensing report was provided along with appeal rights. . LPA obtained resident roster and names of staff. LPA asked facility for LIC500, and facility staff stated they would email it later today. On 08/08/2023 LPA Alberto Lopez made a subsequent visit to facility and met with Administrator Toby Miclat and discussed the purpose of the visit. LPA took a tour of the living room, dining areas, kitchen, common areas, and random resident rooms. LPA did not observe any signs of neglect, abuse or other immediate health and safety risks. LPA requested copies of staff and resident roster, and interviewed four(4) Staff (S#1-S#4) and six (6)residents (R#1-R#6). LPA interviewed four staff (S#1- S#4), six residents (R#1-R#6) and two witnesses (W#1-W#2). Allegation: Staff did not meet residents hygiene needs. It is alleged that facility failed to provide resident with adequate hygiene needs The investigation revealed, LPA interviewed four (4) staff S1-S4 and four (4) of four (4) staff denied the allegation. W1 and W2, who are family members, stated resident had a bad body odor. LPA interviewed six (6) residents R1-R6 and six (6) of six (6) residents could not collaborate the allegation. Administrator denied that facility did not meet resident hygiene needs, and three (3) of three (3) staff stated they provide all residents with proper hygiene needs daily. LPA toured all rooms, all residents were clean, bed linens were clean, and the rooms were free of odors. There is not enough evidence to support this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and copy of report provided to Administrator Toby Miclatthe state’s words, verbatim · CDSS document, Apr 30, 2024 · control 28-AS-20221202102319

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1)(c) · Plan of correction due date: May 1, 2024

87464(f)(1)(c) Basic Services: Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). H&S Code 1569.2(c) “Care and supervision ” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement is not being met as evidenced by: Based on interviews and record review, resident suffered 2 facial fractures while in care at the facility and facility failed to provide medical attention to resident. Lack of care and supervision by facility resulted in staff not knowing resident had facial fractures. The fractures were discovered when resident made visit to emergency room for unrelated health issues.the state’s words, verbatim · CDSS document, Apr 30, 2024

Plan of correction: Licensee to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to train staff on providing care and supervision and send roster with signatures of participants of training to LPA. Licensee to submit a faxed copy of POC by due date of 05/01/2024 Immediate $500 dollar penalty assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 1, 2024

87465(a)(1) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interviews and record review, facility did not contact PCP or arrange to have wound care specialist provide wound care to resident who was admitted to facility with two stage 1 pressure injuries on both heals and developed stage 3 pressure injury on coccyx while in care.the state’s words, verbatim · CDSS document, Apr 30, 2024

Plan of correction: The administrator shall develop a written plan to ensure that residents receive medical attention while in care. The plan shall also include the steps the facility will take when a resident's health condition declines or refuses. This POC is due to LPA by 05/01/2024

Apr 30, 2024Facility evaluation reportReport on file

Type of visit: Case Management - Deficiencies

On 12/05/2022, Licensing Program Analyst (LPA) Alberto Lopez made initial 10-day visit. During this visit LPA met with Acting Administrator Lea Loaiza and explained the purpose of today's visit. LPA conducted a tour of this facility. LPA did not observe any signs of neglect, or abuse, but did observe health and safety risk. LPA cited facility on Case Management report and 809D. LPA also reviewed files for three residents and obtained relevant documentation. LPA obtained resident roster and names of staff. LPA asked facility for LIC500, and facility staff stated they would email it later today. On 08/08/2023 LPA Alberto Lopez made a subsequent visit to facility and met with Administrator Toby Miclat and discussed the purpose of the visit. LPA took a tour of the living room, dining areas, kitchen, common areas, and random resident rooms. LPA did not observe any signs of neglect, abuse or other immediate health and safety risks. LPA requested copies of staff and resident roster, and interviewed four(4) Staff (S#1-S#4) and six (6)residents (R#1-R#6). LPA interviewed four staff (S#1- S#4), six residents (R#1-R#6) and two witnesses (W#1-W#2). 04/30/24 - During today’s visit, LPA took a tour of the facility, including random resident rooms, and common areas of the facility. According to Department interviews, and records reviewed, and observation, The facility was using half rails for resident #1 (1) and #6 (6) without a doctor’s orders which poses an immediate health, safety, or personal rights risk to persons in care. Deficiency is being cited according to California Code of Regulations, Title 22, Division 6 and Chapter 8 Exit interview, a copy of this report and Appeals Rights were provided to the Facility Administrator Toby Miclatthe state’s words, verbatim · CDSS document, Apr 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: May 2, 2024

87608(a)(3) 87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidence by: LPA observed R1 with double half rails and Administrator stated that the facility did not have a doctor’s order for the half bed rails that were used for R1 and R6 bed which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 30, 2024

Plan of correction: Administrator will obtain doctor's orders for R1 and will read section 87608 and send a written letter to LPA indicting that Administrator understood the section and how it facility will prevent this from happening again by POC date.

Feb 23, 2024Facility evaluation reportReport on file

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a Plan of Correction (POC) visit to follow-up on the POC's due on 02/16/24. An annual required visit was conducted on 02/09/24 by LPA Ramirez. During the annual visit, the facility was issued three (3) deficiencies and one (1) Technical Violation. The facility did not clear two (2) out of the three (3) POC’s that had a due date of 2/16/24. The following POC’s are still outstanding: HSC 1569.605 ** LPA Ramirez originally requested proof of liability insurance.** On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. HSC 1569.695(c) **LPA Ramirez originally requested proof of staff re-training on this regulation.** (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. LPA Ramirez spoke with Administrator Toby Miclat and Co-administrator Lea Loaiza by telephone and agreed that LPA Ramirez will receive proof staff re-training on HSC 1569.605 by the end of business on 2/23/24. LPA Ramirez granted an extension to submit liability insurance no later than the end of business on 3/1/24. LPA Ramirez will issue civil penalties in the amount of $700 for each deficiency noted above, 7 days x $100 starting from 2/17/24 till 2/23/24. Exit interview conducted with Caregiver Judith Sabando. A copy of this report and (2) LIC 421FC was provided.the state’s words, verbatim · CDSS document, Feb 23, 2024
Feb 9, 2024Facility evaluation reportReport on file

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 02/00/2024. LPA was met by Caregiver Baltazar Reyes and explained the purpose of the visit. The facility is licensed to serve six (6six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for two (2). LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street and consists of four (4) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory device on entry of door to be operational, sliding door and exits. 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 centrally stored medications in kitchen cabinet to be locked during visit. LPA Ramirez observed sharps and knives near kitchen cabinet to be locked during visit. First aid kit was observed in kitchen cabinet. Emergency food supply was stored in kitchen pantry. Dining Room/Living room/: LPA Ramirez observed plenty of lighting and seating in this area. LPA Ramirez observed several recliners in living room area. One (1) large dining room table with six (6) chairs was observed. Laundry room: LPA Ramirez observed laundry detergent to be locked during visit. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1-4: LPA Ramirez inspected four (4) resident rooms. LPA Ramirez observed all rooms to contain required lighting, furniture, and linen. LPA Ramirez observed auditory device on S6’s bedroom door. Bathrooms 1-2: bathroom# 1 water temperature measured at 106.2-degree F which is within the required 105F - 120F degrees. LPA Ramirez observed Resident bathroom #2 water temperature was measured at 105.6-degree F which is within the required 105F- 120F. LPA Ramirez observed signs promoting proper hand washing. LPA Ramirez observed grab bars near toilet and showers and no slip coating in showers. Backyard: No hazards were observed. Plenty of shade and seating was observed. Garage: LPA Ramirez observed emergency water in this area. Emergency Drills: Last documented fire drill wasdrills were conducted on 01/16/2024 and 02/13/2023. 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 the facility. LPA Ramirez reviewed three (3) personnel records. Documented proof of required annual initial training and annual training was observed. Administrator's Certificate for Lea Loaiza was observed with an expiration date of 9/19/2024. Resident Files: Six (6) resident files and Medications Administration Record (MAR) were reviewed. Liability Insurance & Infection Control Plan: Licensee could not provide liability insurance. LPA Ramirez observed infection control plan however, infection control plan was not observed to comply with Title 22. Deficiencies are being cited. Deficiencies and technical advisories are being cited. A copy of this report, 809-D, and appeals rights were provided to Lea Loaiza.the state’s words, verbatim · CDSS document, Feb 9, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

What the state’s words mean
Substantiatedthe state found the allegation more likely true than notUnsubstantiatedthere was not enough evidence to prove a violation occurred — not a finding of wrongdoingUnfoundedthe evidence showed the allegation was false, could not have happened, or had no reasonable basisType A citationa violation that poses an immediate risk to health, safety or personal rights if it is not correctedType B citationa violation that could become a risk if not corrected, or one involving records, resources or required services

CDSS citation definitions (PDF) ↗ · CDSS complaint outcomes ↗

An “unsubstantiated” complaint is not a finding of wrongdoing — it means the state investigated and could not confirm the allegation. Outcome words are the state’s own; we never grade, score, or color a record, and we publish no reviews — the state’s dated documents and the questions below stand in their place.

Who holds the licence

Stateside Medical LLC, licensed since 2020, operates 3 licensed homes in California. Running more than one home is common and is neither good nor bad on its own.

Life here

Rooms, meals, the rhythm of a day, faith and language, pets and house rules — as the home describes them. Tap any detail for its source and date; nothing here is graded.

The home has not described daily life anywhere we have reviewed yet — that is the case for most small homes, and it says nothing about the home. These questions fill in the picture; keep the ones that matter to you.

Before you call

Ask every home the same questions — the state’s record does not answer these. Keep the ones that matter and they travel with your saved homes.

  1. What is included in the monthly rate, and what costs extra?
  2. Who is awake overnight, and how do residents ask for help?
  3. Which rooms does the non-ambulatory approval cover, and what transfer support is provided?
  4. What could change whether someone can stay here?
  5. Can we see a bedroom and share a meal during a visit?

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