GREEN GABLES CARE FACILITY

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 record of medications administered for R5, the prescription was for medication to be given 1x a day, but staff was giving 2x a day; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/24/2025 Plan of Correction Facility shall retrain staff on Medication Administration procedures per Regulation. Proof of retraining shall be provided to CCL by 11/24/2025, showing the date, time, and place that the training was conducted and who instructed the training. Participating staff signatures shall also be required.

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that R1 and R3 have Medical Assessments stating they are Bedridden, and the facility only has fire clearance for one resident/ which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/24/2025 Plan of Correction Facility shall provide a plan to CCL to address the non-compliance of bedridden residents.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates. 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 bedroom with door leading into the backyard has a chain lock and a nightstand that prevents the door from being opened; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/21/2025 Plan of Correction Facility shall remove the lock and move the nightstand from in front of the exit door.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents an shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. 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 that food provided for the total daily diet was not of quality or variety necessary to meet needs of residents or meet the Recommended Dietary Allowance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/26/2025 Plan of Correction Facility shall provide proof by receipts and pictures, that there is a variety of fresh meat, fruits, and vegetables being provided to the residents.

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 in that there were bugs, insects, pests, sighted in the facility pantry and on the kitchen counter where food is prepared; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2025 Plan of Correction Facility shall provide the name and phone number and receipts from the pest control company that is providing service to the facility.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. 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 that medication was found to be removed from the packaging and stored in plastic cups in the medication cabinet; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2025 Plan of Correction Facility shall provide medication training to all staff and provide proof of training to CCL.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). 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 two residents that are being provided care by a home health agency do not have any documentation of the services agreed to; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2025 Plan of Correction Facilty shall provide the agreement made with the home health agency and keep it in the residents file. The agreement and plan shall be forwarded to CCL.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. 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 one resident, R5, no notification was made to Licensing; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/25/2025 Plan of Correction Facility shall provide the necessary documentation to Licensing, regarding the resident that is receiving hospice care.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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… This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, LPA observed Staff 1 (S1) providing resident care and supervision during inspection. LPA reviewed and confirmed on Facility Personnel Report Summary dated 12/13/2022, S1 not associated with facility. LPA confirmed with CCL front staff if S1 was cleared. Per CCL records, S1 is cleared in other facilities and is not associated with this facility. S1 is not associated and has been providing resident’s care and supervision for two days, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2022 Plan of Correction Staff person is to be removed from the facility and not permitted back until associated with facility. POC cleared during visit.

Official classification

Type B

Official code

87156

Regulation authority

CCR

What the official deficiency says

87156 Licensing Fees (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and interview, the licensee did not pay Annual fees that was due on 10/18/2022, which poses a potential risk to the residents.

Official plan of correction

POC Due Date: 12/19/2022 Plan of Correction Administrator will pay the Annual Licensing fees by 12/19/2022. Administrator will submit proof of payment to CCL.

Official classification

Type A

Official code

87633(b)(4)(B)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility...(4) A description of the area of licensee’s responsibility for implementing the plan... (B)... who will control and supervise the storage and administration of all controlled drugs ...without hospice personnel being present. This requirement was not met as evidence by: LPA’s interviews with S1 and S2, staff stated medication is not pre-drawn for R1. Staff stated the staff at the facility draws it. This possesses a potential threat to resident in care.

Official plan of correction

Licensee will have hospice pre-draw medication. Training will be completed with staff of regulation. A copy of training material land sign in sheet will be provided to CCL by POC date.

Deadline recorded: Aug 11, 2022. A deadline is not proof that correction was completed.