Vmb Ultimate Care

Allegation investigated: Staff did not meet resident care needs

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to House Manager Milagros Bucatcat. During today's visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff. The Department’s investigation consisted of interviews with staff, residents, and outside sources, records review, and a tour of the facility. It was alleged that staff did not meet resident care needs, specific to Resident 1 (R1) not being able to meet their financial needs. Review of R1’s medical assessment dated July 2025 revealed that R1 was diagnosed with a major neurocognitive disorder and was unable to manage their own cash resources but was able to communicate. Continued on LIC9099-C page... Unsubstantiated Interviews with outside sources revealed that there were concerns that R1 did not have a representative to assist R1 with managing R1’s financial and health care needs. Review of R1’s admission agreement dated June 2025 revealed that an individual was listed as R1’s responsible person, however, interviews revealed that the individual had not had contact with R1 for years and had no ability to assist with R1’s financial or health care needs. Interviews with staff and facility management provided conflicting information as they stated that the individual was R1’s responsible party and was responsible for handling R1’s finances. Facility management denied any issues with receiving payment from R1 or any concerns that R1, or any other residents, would be unable to pay for the facility’s basic services rate. Interviews with residents and outside sources did not reveal concerns regarding the care provided at the facility and did not disclose any difficulty with paying for the facility’s services. The Department was unable to interview R1 due to R1’s death in early August 2025. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with House Manager Milagros Bucatcat, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).the state’s words, verbatim · CDSS document, Sep 18, 2025 · control 08-AS-20250716114857

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to cite deficiencies. LPA identified herself to, was greeted by, and explained the purpose of the visit to House Manager Milagros Bucatcat. Review of the Department’s Active Administrator List dated 9/16/2025 revealed that Virgil P. Bucatcat, who is the currently listed Administrator for the facility, did not have an active or pending renewal for an Administrator Certificate, and their latest Administrator Certificate expired in 2013. Additionally, Staff 1, [House Manager was provided with an LIC811 Confidential Names List to identify individuals] who was acting as a facility manager did not have active or pending renewal for Administrator Certificate. Review of an Administrator Certificate for Staff 2 revealed that S2 had an active Administrator Certificate for residential care facilities for the elderly, however, interviews confirmed that facility management had not submitted a Change of Administrator request to the Department. Additionally, Staff 1 stated during multiple conversations that only Residents 1 and 2 were receiving hospice services and Residents 3, 4, 5, 6, and 7 were not receiving hospice services. Staff 1 only provided LPA Borunda with hospice records for R1 and R2. However, interviews with outside sources and review of facility records revealed that Residents 1-7 were under the care of a hospice provider and were receiving hospice services. Residents 1-6 were all admitted to the facility at the same time, which placed the facility over their approved and pending hospice waiver requests. In 2013, the facility was originally approved to admit 2 hospice residents, however in 2022, the facility applied for a hospice waiver increase from 2 to 4 residents. Continued on LIC809-C page... Following a visit from the Department on 7/23/2025, S1 submitted a hospice waiver increase to 6 residents, which is still pending with the Department. Therefore the following deficiencies for lack of active Administrator, false claims, and over capacity for hospice residents are being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D pages. An exit interview was conducted with House Manager Milagros Bucatcat, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Sep 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: Sep 25, 2025

87207 No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement has not been met as evidenced by: Based on interviews and records review, the Licensee did not comply with the section cited above in that S1 stated that only 2 of 6 residents were receiving hospice services, when it was actually 6 of 6 residents. This poses a potential person rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: House Manager will submit a written letter to the Department stating that S1 will be truthful when interacting with representatives from the Department and the LIC9098 Self Certification of Deficiencies Cleared to the Department by POC due date of 9/25/2025. LPA provided House Manager with LIC9098 Self Certification of Deficiencies Cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87407(k)(1) · Plan of correction due date: Sep 25, 2025

87407 (k) Whenever a certified administrator assumes… responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office… This requirement has not been met as evidenced by: Based on interview and record review, the Licensee did not comply with the section cited above in that a written notice of S2 acting at the facility’s administrator was not submitted to the Department. This poses a potential safety risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: House Manager will submit the LIC308, copy of S2's Administrator Certificate, and a written request to change the Administrator to S2 to the Department by POC due date of 9/25/2025. LPA provided House Manager with LIC308 and Change of Administrator Checklist.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87632(a) · Plan of correction due date: Sep 18, 2025

87632 (a) In order accept or retain terminally ill residents… the licensee shall have obtained a facility hospice care waiver from the Department… This requirement has not been met as evidenced by: Based on interview and record review, the Licensee did not comply with the section cited above in that the facility was caring for 6 hospice residents without requesting an hospice waiver for 6 residents. This posed a potential health risk to 6 of 6 residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: House Manager submitted a hospice waiver request for 6 residents after 7/23/2025, which the Department has received and is currently reviewing. DEFICIENCY CLEARED

Type of visit: POC

Licensing Program Analyst (LPA) Rebecca Borunda conducted a plan of correction (POC) visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to House Manager Milagros Bucatcat. On 6/17/2025, the licensee was issued three deficiencies. Deficiency 87355(e)(2) had a POC due date of 6/18/2025 and deficiencies 87465(h)(2) and 87458(a) had POC due dates of 7/17/2025. On 6/18/2025, House Manager provided LPA with proof of correction for deficiency 87355(e). As of today’s date, 7/23/2025, the licensee has not submitted POC to the Department for deficiencies 87465(h)(2) and 87458(a). During today’s visit, LPA Borunda toured the facility, reviewed resident paperwork and staff training documents, and spoke with staff. House Manager stated that a new tenant was renting a room upstairs and provided LPA with background clearance and association paperwork, which LPA was able to confirm with the facility's Guardian Roster. Review of resident records revealed that each resident had a complete and signed medical assessment. House Manager stated staff will receive medication training on 7/25/2025 and provided LPA with training flyer. LPA observed a locked medication box in the refrigerator and observed that the medication cabinet was still unlocked. House Manager stated that they had already purchased the locks, which LPA verified, and their repair person was installing them tonight. LPA granted a POC extension for deficiency 87465(h)(2) until 7/28/2025 and informed House Manager to provide LPA with proof of lock installation and medication training as soon as completed. Therefore, the deficiencies 87355(e)(2) and 87458(a) are corrected. LPA provided House Manager with letters of Deficiency Cleared. LPA also provided LIC178 for POC extension. An exit interview was conducted with House Manager Milagros Bucatcat, whose signature below confirms receipt of a copy of this report, Letters of Deficiency Cleared, LIC178, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Ben Rosario. Manager Milagros Bucatcat arrived during the visit. During today's visit, LPA toured the facility, reviewed facility records, observed residents in care, and spoke with staff. Review of resident records revealed that one resident did not have an initial medical assessment and multiple residents had medical assessments which were incomplete. During the tour of the facility, LPA observed multiple medications stored in the unsecured refrigerator in the kitchen as well as all resident medications stored in an unlocked cabinet in the facility kitchen. LPA spoke with Caregiver Rosario and Manager Bucatcat who stated that the kitchen is normally locked, however, LPA observed the facility kitchen door to remain open and unlocked for a majority of the visit. During the tour of the facility, LPA observed two individuals who Manager Bucatcat stated were not residents or staff. Manager Bucatcat stated that Tenant 1 (T1) was renting a room and Tenant 2 (T2) was their partner. LPA spoke with T1 and learned that T1 has been renting a room for 4.5 years and T2 has been at the facility approximately once a week for 4 months. LPA verified on Guardian that neither individual had active fingerprint clearance or association to the facility. [Manager was provided with an LIC811 Confidential Names List to identify residents, T1, and T2]. Continued on LIC809-C page... Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. LPA provided Manager Bucatcat with a copy of the facility's current Guardian roster, and written documentation regarding the facility's annual licensing fee balance and Administrator Certificate status of Licensee Virgil Bucacat. The following deficiencies were cited for incomplete medical assessments, unsecured medications, and non-cleared individuals and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $1,000 was assessed for T1 and T2 not being finger print cleared and noted on the attached LIC421BG form. An exit interview was conducted with Manager Milagros Bucatcat, whose signature below confirms receipt of a copy of this report, the LIC811, the LIC421BG, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Manage Milagros Bucacat. According to the facility’s license, the facility has a maximum capacity of six (6) clients, of which all may be non-ambulatory. There was a total of four (4) client in care. LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. Hot water temperature was in compliance. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were present. Per staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher and first aid kit present. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff/clients and reviewed multiple staff/client files. The files which LPA reviewed contained all required documents. No deficiencies were cited during today's annual inspection. An exit interview was conducted with Manager to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jun 18, 2024