Merisol Care Home

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Type of visit: Required - 1 Year

On this day, at around 10:30 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection and met with direct care staff Teresita Collong. Administrator Soledad Bacani, Certificate 7011133740 dated 12/21/25 to 12/20/2027, arrived later. During the visit, LPA inspected the facility inside and out, including, but not limited to, bedrooms, bathrooms, the dining area, kitchen, garage, and backyard. Hot water is measured at 120 degrees Fahrenheit. There was a sufficient supply of perishable and non-perishable foods. Supply of linen, warm blankets, and towels was observed. The first aid kit was observed to be complete. was observed to be complete. LPA observed a fire extinguisher charge with the receipt attached, dated 4/22/26. The last fire and earthquake drill was conducted on 4/2/26. Liability Policy: PCI33893478-02 effective 4/8/26 to 4/8/27. Smoke detectors and carbon monoxide were tested and observed to be functional. LPA reviewed 4 resident files and 3 staff files. Report continues on LIC 809c… The following deficiencies were observed: - Observed that the food transfer is not properly stored - Medication/cream/ ointment observed in shared bathroom, and in RM 2 and 3 (repeat dated 4/26/25) - Observed ants inside the shared bathroom - Observed resident 1 (R1) and R2 did not have TB - Files review R3 do not have a bedrail order - Observed shared bathroom drawer is broken. Observed objects such as an electric mattress, a Hoyer lift, multiple metal racks, and a broken drawer around the facility. *Civil penalty of $250 is being assessed on today's date by having a repeat of the citation within 12 months* Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by the plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421IM, and this report are provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Case Management - Other

On 11/05/2025 at 1:00 PM, Licensing Program Analysts (LPAs) K. Nguyen and P .Manalo arrived unannounced to conduct case management to verify that Resident 1 (R1) who is bedridden has moved out of the facility. During the visit, LPAs observation and interview revealed that Resident 1 (R1) was able to move both legs from left right and moved both hands. With the assistance of the Direct Care Staff, Milagros Bumatay, R1 was able to turn from one side to the other holding onto the bed rail. R1 was also able to move her head up while in a laying down position. Record review of the LIC602A dated 10/24/2025 showed that R1 is ambulatory and diagnosed with Alzheimer’s dementia. No deficiencies cited. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Case Management - Other

On 11/05/2025, Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo arrived unannounced to conduct a case management visit. LPAs met with Direct Care Staff, Teresita Collong, and explained the purpose of the visit. While LPAs were at the facility for another visit, LPAs record review revealed that the following documents including but not limited to LIC627C (Consent Form), LIC9158 (Telecommunications Device Notification), LIC601 (Identification and Information), and LIC621 (Resident Personal Property and Valuables) was not signed and/or completed. Record review also revealed that R1 does not have a full bed rail on file. 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 was conducted and Appeal Rights was provided to Collong.the state’s words, verbatim · CDSS document, Nov 5, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(b) · Plan of correction due date: Nov 20, 2025

Postural Supports (B)Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 a full bed rail for R1 which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: The Administrator agrees to request an exception from the department for R1’s full bed rail. Proof of corrections will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Nov 21, 2025

Resident Records (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 a complete file for R1 which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 5, 2025

Plan of correction: The Administrator agrees to complete all the documents needed for R1 and send proof to CCLD by POC date.

Type of visit: Case Management - Other

On 10/22/2025 at 9:45 AM, Licensing Program Analysts (LPAs) K. Nguyen and P.Manalo and arrived unannounced to conduct case management following up on R1 status. Upon the visit LPAs met with Direct Care Staff, Milagros Bumatay and explained the purpose of the visit. The Administrator (ADM) Soledad Bacani was unavailable to come. ADM gave authorization on the phone for Care Staff to sign the report. While at the facility, LPA observed the following deficiencies: During the visit, LPAs observed that Resident 1 (R1) who is bedridden per Physician's Report and is staying in an approved non-ambulatory room. The facility has an approved one bedridden fire clearance for Room #2 only. However, R1 is occupying Room #3. Interview with Direct Care Staff, Teresita, stated that the R1 was discharged from hospice on September 09, 2025. However, interview with Staff 1 (S1) revealed that R1 is unable to move side to side. 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 was conducted and Appeal Rights was provided to Bumatay.the state’s words, verbatim · CDSS document, Oct 22, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87455(b)(7) · Plan of correction due date: Oct 30, 2025

87455(b)(7) Acceptance and Retention Limitations (b)The following persons may be accepted or retained by the licensee: (7) Persons who are bedridden provided the requirements of Section 87606 are met. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above by having R1 in Room# 3 that is not approved for bedridden which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 22, 2025

Plan of correction: The Administrator agrees to placed R1 in an approved bedridden room per facility sketch and provide an updated physician’s report (LIC602A) to determine R1’s ambulatory status. Proof of correction will be sent to CCLD by POC date.

Type of visit: Case Management - Other

On 10/03/2025 at 8:20 AM, Licensing Program Analysts (LPAs) K. Nguyen and P .Manalo and arrived unannounced to conduct case management to verify that Resident 1 (R1) who is bedridden has moved out of the facility. During the visit, LPAs observation and interview revealed that Resident 1 (R1) has been moved out of the facility. Staff 1 (S1) stated that the resident moved to a different facility per conservator. No deficiencies cited. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Case Management - Legal/Non-compliance

On 10/03/2025 at 9:00 AM, Licensing Program Analysts (LPAs) K. Nguyen and P.Manalo and arrived unannounced to conduct case management legal/Non-compliance visit and met with Direct Care Staff, Teresita Collong and explained the purpose of the visit. The Administrator was unavailable to come. While at the facility, LPA observed the following deficiencies: During the visit, LPAs observed that Resident 1 (R1) who is bedridden per Physician's Report and is staying in an approved non-ambulatory room. The facility has an approved one bedridden fire clearance for Room #2 only. However, R1 is occupying Room #3. Interview with Direct Care Staff, Teresita, stated that the R1 was discharged from hospice on September 09, 2025. However, interview with Staff 1 (S1) revealed that R1 is unable to move side to side. Administrator not present for a sufficient enough hours. The auditory signal in the kitchen/living room sliding door was not working. 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. Civil penalty of $750 for fire clearance violation is issued today. Exit interview was conducted and Appeal Rights was provided to Collong.the state’s words, verbatim · CDSS document, Oct 3, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Oct 4, 2025

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above by having R1 in RM 3 that is not approved for bedridden. R1 physician report dated back in March 2025 showed that R1 is bedridden which poses a immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: The Administrator agrees to notify the fire department of the bedridden resident within 24 hours and send proof to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Oct 20, 2025

(a) All facilities shall have a qualified and currently certified administrator…The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not being present at the facility for sufficient hours which poses a safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: The Administrator agrees that the facility will hire a new full time qualified administrator per regulation requirements and send proof to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(d) · Plan of correction due date: Oct 17, 2025

(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having the auditory device in the kichen/living room sliding door off which posed a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: The Administrator agrees to send an audio video 3 times a day every day for the next two weeks and send proof to CCLD by POC date.

Type of visit: POC

Licensing Program Analyst (LPA) Luisa Fontanilla conducted a proof of correction (POC) visit. LPA met with Soledad Bacani, Administrator and informed her about the purpose of visit. On this day, 9/4/25 civil penalty is assessed as follows: Sec. 87611 (a)(3) 13 days x 100 = 1300 - Cleared on 9/4/25 Sec. 87611(c) 5 days x 100 = 500 - Cleared on 9/4/25 Sec 87457 (c) 3 days x 100 = 300 - Cleared on 8/25/25 The civil penalty was discussed with the Bacani. Civil Penalties in the total amount of $2,100.00 is assessed today for failure to meet/submit POCs date for deficiencies. All deficiencies have been cleared as of 9/4/2025.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Case Management - Legal/Non-compliance

LPA L. Fontanilla arrived unannounced to conduct case management legal/Non-compliance visit and met with Licensee/Administrator Soledad Bacani. During the visit, the facility was issued a deficiency and civil penalty for having Resident 1 (R1) who is bedridden per Physician's Report and LPA observation stay in a non-ambulatory room. The facility has an approved one bedridden fire clearance for Room #2 only. R1 is occupying Room #4. Civil penalty of $500 for fire clearance violation is issued today. Exit interview was conducted and Appeal Rights was provided to Bacani.the state’s words, verbatim · CDSS document, Sep 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80010(a) · Plan of correction due date: Sep 5, 2025

80010 Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including the capacity limitation This requirement is not met as evidenced by: R1 currently occupies a non-ambulatory room (Rm#4). Based on LPA observation and Medical assessment, R1 is bedridden.Facility has one approved bedridden room(Rm#2)the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: The Administrator will notify the local fire department about R1 and will apply for additional bedridden fire clearance within 24 hours.

Type of visit: Case Management - Legal/Non-compliance

At around 1pm, LPA Luisa Fontanilla conducted a case management-legal/non-compliance visit and met with staff Gloriosa Mamauag and Milagros Bumatay. LPA explained to Mamauag the purpose of visit. The Administrator was notified on the phone about LPA presence. Administrator authorized Collong to sign the report. During the visit, LPA checked all doors with auditory devices and observed devices in Rooms 3 and 4 were turned off. LPA asked staff Milagros why the devices were off and who instructed staff to turn the off. She states that they decided to turn it off and that no one gave them the instruction. Deficiency is cited per Title 22 California Code of Regulations (see Lic 809D). Civil penalty of $250.00 is assessed for repeat violation. Exit interview was conducted and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Aug 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Aug 25, 2025

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on observation, the auditory devices in Rooms 3 and 4 were off which poses an immediate risk to health and safety of clients under care.the state’s words, verbatim · CDSS document, Aug 22, 2025

Plan of correction: The Administrator will designate a staff to check and make sure all auditory devices are on and functional and submit proof to CCL by POC date.

Type of visit: POC

Licensing Program Analyst (LPA) Luisa Fontanilla conducted a proof of correction (POC) visit. LPA met with Soledad Bacani, Administrator and informed her about the purpose of visit. On 8/7/25, LPA issued a citation deficiency section # 87611(a)(3) with due date 8/8/25 and 87611(c) and Sec 87457 (c) with due date 8/15/25 under case management legal-non compliance visit Administrator submitted an incomplete POC for sec 87611(a)(3) and failed to submit POC for sec 87611(c). On this day, 8/22/25 civil penalty is assessed as follows: Sec. 87611 (a)(3) 14 days x 100 = 1400 Sec. 87611(c) 7 days x 100 = 700 Sec 87457 (c) 7 days x 100 = 700 The civil penalty was discussed with the Collong. Civil Penalties in the total amount of $2,800.00 is assessed today for failure to meet/submit POCs date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies are corrected. Exit interview was conducted with Bacani. Appeal Rights, LIC421FC Civil Penalty Assessment, and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 22, 2025

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct case management legal/non-compliance visit. LPA was met by staff Gloriosa Mamauag. The Administrator was informed about the visit over the phone. Staff Teresita Olong was authorized by Bacani to sign the report. Soledad Bacani arrived at the facility at around 2:15 pm. During the visit, LPA observed the following deficiencies: auditory device in the kitchen sliding door is not functional facility admitted Resident 1 (R1) with right leg contracture without approval from CCL; facility is in an NCC compliance plan R1 has been sleeping in the staff room which is not approved by the Fire Department as resident room no staff training on how to care for R1's contracted leg R1's Appraisal Needs and Services Plan incomplete, no preplacement appraisal Civil penalty of $500 assessed for today's visit. Exit interview was conducted with Olong/Bacani and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Aug 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Aug 8, 2025

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: LPA observed auditory device in the kitchen sliding door is not functional which poses an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Aug 7, 2025

Plan of correction: Administrator will check all auditory devices in all exits and ensure all are functional. Administrator will create a daily inspection log of all the auditory devices starting 8/8/2025 and notify CCL by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87203 · Plan of correction due date: Aug 8, 2025

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on interview conducted, R2 has been sleeping in the staff room which poses an immediate health and safety risk.the state’s words, verbatim · CDSS document, Aug 7, 2025

Plan of correction: By POC date, the Administrator will move R2 to the appropriate room and notify CCL. Civil penalty of $500 is assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87611(a)(3) · Plan of correction due date: Aug 8, 2025

87611 General Requirements for Allowable Health Conditions (a) Prior to accepting or retaining a resident with an allowable health condition as specified in Section 87618, Oxygen Administration - Gas and Liquid; Section 87619, Intermittent Positive Pressure Breathing (IPPB) Machine; Section 87621, Colostomy/Ileostomy; Section 87626, 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: (3) A Non-Compliance Conference as defined in Section 87101(n) that resulted in a corrective plan of action This requirement is not met as evidenced by: The facility admitted R1 who has contracture of the right leg without approval from CCL. The facility is in a non-compliance correction plan. R1 is not able to care for own needs, and has Dementia.the state’s words, verbatim · CDSS document, Aug 7, 2025

Plan of correction: The facility will submit request for exception for R1 by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87611(c) · Plan of correction due date: Aug 15, 2025

87611 General Requirements for Allowable Health Conditions (c) In addition to Section 87411(d), facility staff shall have knowledge and the ability to recognize and respond to problems and shall contact the physician, appropriately skilled professional, and/or vendor as necessary. This requirement is not met as evidenced by: There is no proof of staff training on file in regards to how to care for R1's contracted right leg. R1 is not able to care for own needs.the state’s words, verbatim · CDSS document, Aug 7, 2025

Plan of correction: The Administrator will have all staff undergo training on how to care for R1's contracted leg and submit proof to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Aug 15, 2025

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. R1 has right leg contracture but no preplacement appraisal was conducted. ANS is observed incomplete.the state’s words, verbatim · CDSS document, Aug 7, 2025

Plan of correction: The Administrator will complete R1's ANS and submit a copy to CCL by POC date.

Type of visit: Required - 1 Year

On this day at around 10:00 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection and met with Administrator, Soledad Bacani. LPA explained to Bacani the purpose of the visit. During the visit, LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, dining area, kitchen, garage and backyard. Hot water measured at 125.7 degrees Fahrenheit. There was sufficient supply of perishable and non perishable foods. Ample supply of linen, warm blankets and towels were observed. First aid kit was observed complete. LPA observed a fire extinguisher that appeared full but did not have a tag or proof of purchase. The last fire and earthquake drill was conducted in March, 2024. Smoke detectors and carbon monoxide were tested and observed functional. LPA reviewed 5 resident files and 4 staff files. Report continues on LIC 809c… The following deficiencies were observed: · Observed hot water at 125.7 Fahrenheit · Observed transfer food are not properly storage · Chemical observed underneath kitchen sink and shared bathroom. · Medication/cream/ ointment observed in shared bathroom, in refrigerator · knives observed unlocked in the kitchen in a lock box, however not being lock. · Expired salsa/sauce observed to be on kitchen counter · Observed cockroach inside the cabinet and dinning table · Observed staffs without CPR and First Aid · Observed three staff do not have training on files · Observed resident did not have TB · Observed No plan of Operation · Observed toilet cannot flush · Observed last fire drill was conducted March 2024 · Observed bedridden in room number 3, however facility approved bedridden in room number 2 · Observed room 3 resident have oxygen, however there are no smoking sign posted in room 3 · Staff using the living room as a sleeping area Exit interview was conducted with the Administrator and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Apr 24, 2025