Merisol Care

Type of visit: Required - 1 Year

On 06/03/2026 at 11:35 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Antonia Mari, and explained the purpose of the visit. Administrator certificate is current. LPA toured facility with inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents, and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. The hot water temperature in the residents shared bathroom was measured at 107.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 08/04/2025. Fire drill was last conducted on 04/04/2026. At 12:35 PM, LPA reviewed 6 residents records. At 1:09 PM, LPA reviewed 3 staff records and all have first aid certification and associated to the facility. At 3:30 PM, LPA reviewed two samples of residents’ medications. Continue to LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/11/2026: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan LIC9020 Register of Client/ Resident Roster THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:47 AM, LPA observed a commode in the backyard, multiple light bulbs missing in R5's room and living room, and a handle missing in R3's bathroom drawer. At 1:00 PM, LPA observed unlocked zinc oxide ointment and thick it. At 1:15 PM, record review revealed that R2 and R5 does not have an updated medical assessment and R2 and R5's current medical assessment does not have ambulatory status. At 2:30 PM, record review revealed that the facility does not have sufficient coverage on the liability insurance At 3:08 PM, record review revealed that R2 does not have a bed rail order. At 4:00 PM, LPA observed that there is no doctor’s order for R2 and R4’s medication and R2’s Centrally Stored Medication and Destruction Record (LIC622) not updated. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 3, 2026

The state marks this report as 12 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

On 02/24/2026 at 1:55 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 02/18/2026 that indicated that R1 passed away on 02/08/2026 at 1:05 PM. LPA met with Administrator (ADM), Antonia Mari, and explained the purpose of the visit. During the visit, LPA reviewed facility’s incident report, death report, physician report, appraisal needs and services plan, hospice binder, and Physician Orders for Life-Sustaining Treatment (POLST). LPA spoke with ADM who stated that R1 was on hospice and R1's health was declining. ADM stated that R1 on puree diet and was not consuming much. During the visit, LPA and ADM spoke with hospice agency to obtain progress notes of R1 while on hospice. LPA may return at a later time. The following deficiencies were observed: At 2:05 PM, LPA observed Peridex in the bathroom. At 2:25 PM, LPA observed that the death report was reported to CCLD on 02/18/2026 but R1 passed away on 02/08/2026. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with staff. Appeal Rights, LIC421FC, and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 25, 2026

87465(h)(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the licensee did not comply by having unlocked medication of Peridex in the bathroom which posed an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: The Administrator locked the item during the visit. Deficiency cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Mar 4, 2026

87211(a)(1)(A)Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above by not reporting the death of R1 within seven days of occurrence which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: The Administrator agrees to review the regulation and self-certify. Proof of correction will be sent to CCLD by POC date.

Type of visit: Case Management - Other

On 10/07/2025 at 9:05 AM, Licensing Program Analysts (LPAs) P.Manalo and K.Nguyen arrived unannounced to conduct a Case Management visit to follow up on the admission of Resident 1 (R1). Direct Care Staff, Emma Ang, contacted Teresita Collong and explained the purpose of the visit. Administrator was unavailable to come to today's visit and gave authorization for Teresita to sign the report. During the visit, LPAs reviewed R1's physician report, appraisal needs and services plan, and hospice binder. Record review showed that R1 was admitted to hospice on 09/24/2025. Physician report showed that R1 is non-ambulatory and has a contracture. LPAs observed the following deficiencies during the visit: Record review showed that R1 is on hospice and the facility did not send hospice notification to licensing. Physician report dated 09/22/2025 showed that R1 is diagnosed with contracture without prior exception approval from the department. Record review showed that R1's hospice binder is incomplete and not available for review during the visit. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with staff. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 7, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87211(a)(1) · Plan of correction due date: Oct 17, 2025

87211(a)(1) Reporting Requirements (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not sending a report to licensing that R1 was on hospice when admitted to the facility which posed a potential safety risk to person in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: The Administrator agrees to self certify the regulation, send a hospice notification to licensing, and send proof to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87611(a) · Plan of correction due date: Oct 17, 2025

87611(a) (a) Prior to accepting or retaining a resident with an allowable health condition as specified...Contractures; or Section 87631, Healing Wounds; licensees who have, or have had, any of the following within the last two years, shall obtain Department approval: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by admitting R1 with a health condition without prior approval from the department which poses a potential safety risk to person in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: The Administrator agrees to request an exception to retain R1 and send the following documents including but not limited to appraisal needs and services plan, physician's report, doctor's order for hospice, proof of staff training, and hospice care plan/assessment. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Oct 17, 2025

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having R1's complete hospice binder at the facility available for review which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: The Administrator agrees to obtain and maintained R1's files including hospice binder and send proof to CCLD by POC date.

Type of visit: Case Management - Other

On 06/20/2025 at 8:30 AM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to deliver an amended report from the annual visit that occurred on 05/28/2025. LPA met with Direct Care Staff, Teresita Collong, and explained the purpose of the visit. Amended report delivered. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 20, 2025

Type of visit: Required - 1 Year

On 05/28/2025 at 9:45 AM, Licensing Program Analyst (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator, Antonia Mari, and explained the purpose of the visit. Administrator certificate is current. LPA toured facility with inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 116.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 06/24/2024. Emergency Disaster Plan was last posted on 09/01/2024. At 10:07 AM, LPAs reviewed 6 residents records. At 10:32 AM, LPAs reviewed 3 staff records and all are associated to the facility. At 12:30, LPAs reviewed a sample of resident’s medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/04/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:00 AM, LPA observed Robitussin Cough Medicine unlocked in the fridge. At 11:03 AM, LPA observed that all the residents’ files were incomplete including the Appraisal Needs and Services, Physician's Report, Emergency ID form, Consent Form etc. At 11:32 AM, during record review and interview, there is no emergency drills conducted. At 12:07 PM, LPA observed that R3 and R5 have full bed rails with no doctor's order. At 12:08 PM, LPA observed that R1, R2, R4, R6 did not have doctor's order for the 1/2 bed rails. Continue to LIC809-C... Continue from LIC809-C... At 12:24 PM, LPAs observed that the facility's side gate is locked. Staff interview indicated that the staff locks the gate at night. At 12:30 PM, LPAs observed that that the PRN Medications did not have a doctor's order. At 12:32 PM, LPAs observed the facility does not have a full first aid kit. At 11:40 AM, LPAs observed that all 3 staff do not have CPR certification. At 11:43, LPAs observed that the facility did not have the Personal Rights poster and Ombudsman poster. At 11:52 AM, LPAs observed uneven pavement towards the side gate exit from the ramp. At 11:57 AM, LPAs observed that all 3 files were incomplete during record review. At 11:59 AM, during record review and interview, there was no training's documented for staff. At 12:00 PM, LPAs observed trash bags filled with diapers outside the trash bin in the backyard side gate area. At 12:10 PM, LPAs observed the facility has two hospice residents and only has a hospice waiver approved for one. At 12:12 PM, LPAs observed the facility did not have enough canned goods. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Required - 1 Year

On 06/12/2024 at 09:20 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Licensee Antonia Mari and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. At 10:02 am LPA reviewed 6 residents records. At 10:45 am, LPA reviewed 3 staff records and 3 of 3 were fingerprint cleared and associated to the facility. Continued on LIC 809C... ...Continued from LIC 809 The following deficiency was observed during the visit: Medication unlocked Complaint Poster incorrect size No updated medical assessment for R5 with dementia No medical assessment for R2, R3, R4 No staff record for S2 Administrator certificate expired/not renewed Fire Extinguisher has not been serviced or replaced since May 9th 2023 The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 12, 2024