Merisol Care Home

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.