Merisol Care Home

On this day, LPA Luisa Fontanilla conducted a case management visit related to complaint #15-AS-20231218143948 and met with Soledad Bacani, Administrator. LPA explained to Bacani the purpose of the visit. During the course of investigation, staff interviewed were aware about R1’s confusion and exit-seeking behavior. Staff interviewed state R1 would walk around the facility looking for exits saying, “I want to go home.” Staff were also aware about R1’s elopement incident from a Memory Care unit in another facility prior to placement to this facility. Despite awareness and observing R1’s wandering behavior, R1 was able to leave the facility without staff knowledge on 12/7/2023. R1 was found deceased by the railroad tracks. Deficiency is cited per Title 22 California Code of Regulations (refer to Lic 809D). A copy of this report was provided to the Administrator and Appeal Rights was provided.

On this day at around 10:20 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection and met with staff Milagros Bumatay. LPA explained to Bumatay the purpose of the visit. The Administrator arrived at around 11 am. 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 111 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 November 2023. Smoke detectors and carbon monoxide were tested and observed functional. LPA reviewed three resident files and 4 staff files. All staff were observed fingerprint cleared and associated to the facility. LPA interviewed one resident and one staff. LPA reviewed medications and Medications Administration Record (MAR) with Administrator. The following deficiencies were observed: R1's exit door was observed blocked backyard was observed with grass more than 1 foot tall, construction equipment, luggage, right side passageway uneven pavement, garage door needed to be opened manually 2 knives observed unlocked in the kitchen carrots with mold in the garage R1 uses oxygen but fire department has not been notified missing No Smoking sign on R1's door continuation on Lic 809C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Exit interview was conducted with the Administrator and Appeal Rights was provided.

On this day at around 10:30 am, Licensing Program Analyst (LPA) Luisa Fontanilla conducted a case management-health checks in connection with complaint #15-AS-20231218143948. LPA met with Administrator Soledad Bacani. During the visit, LPA inspected the facility inside and out including but not limited to resident rooms, common areas, bathroom and backyard. Hot water measured at 115 degrees Fahrenheit. There was sufficient supply of perishable and non perishable foods. LPA checked alarms installed on each exit door and observed auditory device in Room 4 is not functional. One resident was observed sitting on the recliner in the living area watching TV/napping. The other two residents are in their respective rooms who both state they are doing okay. In the back and side yards, LPA observed construction materials such as planks of wood, chair, dresser, gravel and different tools. Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted and Appeal Rights was provided.

On this day at around 1:45 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct a case management-incident visit and met with Administrator Soledad Bacani. LPA explained to Administrator the purpose of the visit. On 12/7/2023, Administrator left vm to LPA regarding Resident 2 (R2) missing from the facility. On 12/11/23, LPA made a follow up with Administrator. Administrator informed LPA that Resident 2 (R2) who had Alzheimer's Disease left the facility on 12/7/23 without staff knowledge. Administrator and staff tried to find R2 but failed. Administrator states she informed R2's family and Union City Police Department. And on 12/10/23, Administrator states R2's husband informed staff 1 (S1) that R2 passed away on 12/8/23. During the visit, LPA obtained the following records for Resident 1 (R1): Medication Administration Record (MAR) Physician's Report Admission Agreement Appraisal Needs and Services Plan Death Report Incident Report The deficiency is cited (refer to Lic 809D) from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview was conducted with Soledad. Appeal Rights was provided.

At around 10 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct a case management visit. LPA was met by staff Milagros Bumatay and informed the purpose of the visit. Administrator arrived at the facility at around 10:45am . On 9/15/2023, facility self reported an incident when Resident 1 (R1) with Dementia and is not able to leave the facility unassisted left the facility without staff knowledge. R1 was found by a concerned citizen, was brought to the nearby Fire station. R1 was then sent to Kaiser to get checked. R1 did not sustain any injury per Administrator. During the visit, S1 states that R1 exited through the side door. And that an alarm has been installed right after the incident. Administrator states R1 was given new medicine. Type A deficiency is cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted with Administrator and Appeal Rights was provided.

On 2/17/2023, at 2:25PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct an Annual Infection Control Visit. LPA was greeted by Soledad, Bacani-Licensee and explained the purpose of todays visit. During the inspection, LPA toured facility including but not limited to front entrance, kitchen, common areas, hand washing stations, bedrooms, bathrooms, and backyard. LPA observed COVID-19 signage throughout the facility. Hand washing signs were posted at hand washing stations. LPA observed paper supplies and PPEs are sufficient. Facility has a sufficient 2-day perishable and 7-days non-perishable food supply. All toxins were locked up and inaccessible to residents in care. Common areas are disinfected frequently throughout the day. Fire extinguisher was last serviced on 11/15/2022. Facilities room temperature is maintained at 70 Degrees F. First aid kit is complete. Carbon monoxide and smoke detectors are functional. Facility passages inside and out are free of obstruction and does not pose a health and safety risk for persons in care. During record review, LPA observed facility has a copy of their Infection Control Plan and Disaster Plan on file. Continue on Lic809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from Lic809 The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. At 2:51PM, LPA observed ants in the kitchen cabinet on a bottle of honey. At 2:53PM, LPA observed unlocked knives in kitchen draw accessible to residents. At 3:18PM, LPA observed hot water temperature in common area bathroom at 135.9 Degrees F. Exit interview conducted with Licensee, and a copy of this report provided along with appeal rights.