GREENLEAF 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 in medication in an unlocked kitchen cabinet which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2025 Plan of Correction Administrator immediately removed medication and placed in an locked drawer. Deficiency cleared during visit.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview the Licensee did not comply with the section cited above in having S3 associated to the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2025 Plan of Correction Administrator agreed to associate or submit LIC9182 and a copy of S3's identification to CCLD by POC date.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in not having S2 health screening which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2025 Plan of Correction Administrator agreed to obtain S2 health screening and send self certifying email to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in a disrepair exit door in garage which poses a potential safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2025 Plan of Correction Administrator agreed to repair or replace door and send a photo email to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in bed mattress, Hoyer lifts, wheel chairs, furniture, boxes and wooden shelf in garage and backyard which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2025 Plan of Correction Administrator agreed to remove items from garage and backyard. Administrator will send a photo email of cleared garage and backyard to CCLD by POC date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 not having volunteer associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Administrator had volunteer leave immediatley. Deficiency cleared during visit

Official classification

Type A

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. ..... 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 not having S3 health screening which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Administrator agreed to provide an email of S3 health screening to CCLD by the POC date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 having scissors inside an unlocked kitchen drawer which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Caregiver immediately locked scissors in kitchen drawer. Deficiency cleared during visit.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 having laundry detergent in an unlocked closet which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/20/2024 Plan of Correction Caregiver immediately locked closet with laundry detergent . Deficiency cleared during visit

Official classification

Type B

Official code

80087(a)(1)

Regulation authority

CCR

What the official deficiency says

80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other 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 in having roaches in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator agreed to provide an email of pest control invoice with services provided by pest control company to CCLD by POC date

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation 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 broken refrigerator handle in kitchen which poses safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Administrator agreed to repair or replace refrigerator and provide CCLD an email of photos by POC date

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 not having all residents in care Appraisal Needs and Service Plan in residents files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/23/2024 Plan of Correction Administrator agreed to complete and file Appraisal Needs and Service Plans for all residents in care and provide a self certifying email to CCLD by POC date

Official classification

Type B

Official code

87618(b)(3)(I)

Regulation authority

CCR

What the official deficiency says

Oxygen Administration - Gas and Liquid(b) In addition to Section 87611(b), the licensee shall be responsible for the following:(3) Ensuring that the use of oxygen equipment….:(I) Equipment shall be removed from the facility when no longer in use by the resident. This requirement was not met as evidence by: Based on observation, licensee failed to ensure that unused oxygen tank from a former resident remove from the facility, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated that she will call the company to pick up the oxygen tank. Picked up by the oxygen company during LPA's visit. Cleared and corrected.

Deadline recorded: Apr 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above in LPA observed two cans of paints were observed at the patio area which was accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Staff locked the cans of paints. Corrected during visit.

Deadline recorded: Apr 4, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

f)The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 LPA observed knives at the kitchen drawer was not locked which was accessible to dementia residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2022 Plan of Correction Facility staff locked the drawers for knives, and locked the medication cabinet. Administrator agreed to train all the staff and discuss the regulation cited above, copy of training, name of staff and signatures need to be submitted to CCL by 8/15/2022.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 LPA observed unlocked cabinet and hallway closet with poisonous cleaning products was found under the kitchen sink and •LPA observed unlocked centrally store medication drawer which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/11/2022 Plan of Correction Facility staff locked the cabinets for disinfectant and drawers for medication. Administrator agreed to train all the staff and discuss the regulation cited above, copy of training, name of staff and signatures need to be submitted to CCL by 8/15/2022.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 poisonous cleaning products was found under the kitchen sink was was not locked which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2021 Plan of Correction Corrected. Facility Administrator and staff locked cleaning products.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 the facility sliding door going out to the backyard was hard to open which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 09/17/2021 Plan of Correction Administrator need to fix sliding door, proof of correction need to be submitted on sept. 17,2021.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 Licensee failed to keep one week on non-perishable food which poses/posed a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 09/01/2021 Plan of Correction Administrator will need to send proof of grocery receipt and photo of pantry showing non-perishable food supplies.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f)The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 knives at the kitchen drawer was not locked which was accesible to dementia residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2021 Plan of Correction Corrected. Facility staff locked the knives drawer.