MERISOL CARE HOME

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having medication/cream/ ointment observed in shared bathroom, and in RM 2 and 3 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2026 Plan of Correction Administrators agree to lock all medication/ cream/ and ointment and check all rooms to ensure that all medication is locked away. The administrator will conduct an in-service training on the cited reg. The Administrator will submit proof of correction to CCLD by the POC date. Training will be submitted within a week of the POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above in observation in 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. which poses/posed a potential health, safety or personal rights risk to persons in care.Observed shared bathroom drawer is broken.

Official plan of correction

POC Due Date: 05/04/2026 Plan of Correction Administrators agree to have all items removed from the clean shared bathroom and to submit proof of correction to CCLD by the POC date via photo and email.

Official classification

Type B

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

(23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited by observation that the food transfer is not properly stored which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2026 Plan of Correction Administrators agree to label, clean, and store the refrigerator, and to submit proof of correction to CCLD by the POC date via photo and email.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above by not having resident 1 (R1) and R2 without a TB clearance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2026 Plan of Correction Administrators agree to obtain R1 and R2 TB clearance and to submit proof of correction to CCLD by the POC date via email.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in files review R3 do not have a bedrail order which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2026 Plan of Correction Administrators agree to obtain the R3 bedrail and to submit proof of correction to CCLD by the POC date via email.

Official classification

Type B

Official code

87608(a)(5)(b)

Regulation authority

CCR

What the official deficiency says

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.

Official 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.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

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.

Official plan of correction

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

Deadline recorded: Nov 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87455(b)(7)

Regulation authority

CCR

What the official deficiency says

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.

Official 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.

Deadline recorded: Oct 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(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.

Official 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.

Deadline recorded: Oct 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

(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.

Official 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.

Deadline recorded: Oct 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

(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.

Official 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.

Deadline recorded: Oct 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

80010(a)

Regulation authority

CCR

What the official deficiency says

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)

Official plan of correction

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

Deadline recorded: Sep 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

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.

Official 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.

Deadline recorded: Aug 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

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.

Official 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.

Deadline recorded: Aug 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

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.

Official plan of correction

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

Deadline recorded: Aug 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87611(a)(3)

Regulation authority

CCR

What the official deficiency says

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.

Official plan of correction

The facility will submit request for exception for R1 by POC date.

Deadline recorded: Aug 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87611(c)

Regulation authority

CCR

What the official deficiency says

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.

Official 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.

Deadline recorded: Aug 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

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.

Official plan of correction

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

Deadline recorded: Aug 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by water at 125.7 Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2025 Plan of Correction Administrator will adjust hot water and send photo to CCLD by 4/25/25.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having Chemical underneath kitchen sink and shared bathroom. which poses an immediate health, safety or personal rights risk to persons in care

Official plan of correction

POC Due Date: 04/25/2025 Plan of Correction Administrator will lock up all chemical and send photo to CCLD by 4/25/25.

Official classification

Type A

Official code

1569.695(a)(7)(E)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (7) Procedures that address, but are not limited to, all of the following: (E) Storage and preservation of medications, including the storage of medications that require refrigeration. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having medication/cream/ ointment observed in shared bathroom, in refrigerator not lock which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2025 Plan of Correction Administrator will lock up all medication and cream send photo to CCLD by 4/25/25.

Official classification

Type B

Official code

87208(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (11) A description of the ways in which the licensee will address resident behavioral expression as defined in Section 87101, Definitions, including resident assessments, care practices, and safety measures. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above Observed No plan of Operation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/08/2025 Plan of Correction Administrator will submit plan of operation to CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in Observed cockroach inside the cabinet and dinning table which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/08/2025 Plan of Correction Administrator will conduct/or plan on the process of eliminating the cockroach to CCLD by POC date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in Observed toilet cannot flush which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/08/2025 Plan of Correction Administrator will repair the toilet to CCLD by POC date.

Official classification

Type B

Official code

87307(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage, storage area, shed or similar detached building. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, the licensee did not comply with the section cited above in Staff using the living room as a sleeping area which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2025 Plan of Correction Administrator will remove all belonging and not allow any staff to using the facility space as their own space, submit self-certification the understanding of cited regulation to CCLD by POC date.

Official classification

Type B

Official code

87309(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (2) Any items in subsection (a)(1) that are transferred from their original container to another container shall have a legible label that indicates: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having knives left unlocked in the kitchen in a lock box, however not being lock, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/25/2025 Plan of Correction Administrator will lock up all knives and send picture to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not comply with the section cited above in recored reviewed staffs without CPR and First Aid which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator will have staffs submit CPR and First Aid certificate and send picture to CCLD by POC date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review), the licensee did not comply with the section cited above in recored review three staff do not have training on files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator will have a complete file in facility by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having expired salsa/sauce observed to be on kitchen counterwhich poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator will go over all the food and organized all the food and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above LPA observered cockroach in the kitchen dinning table which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator will clear food from counter, and properly storage and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. Recored reviewed resident did not have TB which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/28/2025 Plan of Correction Administrator will submit proof of resident TB clearance to CCLD by POC date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not comply with the section cited above. Recored reviewed last fire drill was conducted March 2024 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator will conduct fire drill and submit proof to CCLD by POC date.

Official classification

Type B

Official code

1569.72(f)

Regulation authority

HSC

What the official deficiency says

(f) Notwithstanding the length of stay of a bedridden resident, every facility admitting or retaining a bedridden resident, as defined in this section, shall, within 48 hours of the resident’s admission or retention in the facility, notify the local fire authority with jurisdiction in the bedridden resident’s location of the estimated length of time the resident will retain his or her bedridden status in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed bedridden in room number 3, however facility approved bedridden in room number 2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrator submit a plan upon the bedridden resident in room number 3, however they are approved to be in room number 2 to CCLD by POC date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed room 3 resident have oxygen, however there are no smoking sign posted in room 3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2025 Plan of Correction Administrators put up no smoking sign on room 3 and submit photo to CCLD by POC date.