ROLLING GREEN SENIOR CARE

Official classification

Type B

Official code

87468.2(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations ..., personal care and assistance.. " This requirement was not met with evidence by: (3) three out of (3) three residents bedroom were equipped with surviellance cameras and residents were not given informed consent permitting the cameras which posed a potential health and safety risk to the resident in care.

Official plan of correction

The cameras were immediately removed. Administrator agreed to complete an out-service training pertaining to residents personal rights. The training certificate will be submitted to LPA via email by close of business on 2/26/2026.

Deadline recorded: Feb 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(14)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (14) To have reasonable access to telephones, to both make and receive confidential calls. This requirement was not met with evidence by: (1) out of (4) four residents were not given access to their personal cellphone which posed a potential health and safety risk to the resident in care.

Official plan of correction

Administrator agreed to complete an out-service training pertaining to residents personal rights. The training certificate will be submitted to LPA via email by close of business on 2/26/2026.

Deadline recorded: Feb 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews and records review, the licensee did not comply with the section cited above in (1) one of (2) two staff did not have the required completed (20) hour annual training which poses a potential health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 01/13/2026 Plan of Correction Training's will be completed by 01/13/2026 but cannot be use to supplement the required training for 2026. Proof of completion will be forwarded to LPA via email by Close of Business on 1/13/2026.

Official classification

Type B

Official code

87468.2(a)(5)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (5) To be served food of the quality and quantity necessary to meet their nutritional needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interview, the licensee did not comply with the section cited above as facility maintained the (2) day supply of perishable foods but foods lacked of nutritional value. Lacking fresh produce and maintained a high quantity of processed meals which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/31/2025 Plan of Correction Licensee will provide proof of grocery store receipt reflecting the purchase of the perishable foods of nutritional value by 12/31/2025, along with an updated meal and snack calendar of meal and snack being served to the residents. The calendars are to be created weekly for one month and submitted to LPA to ensure compliance, forwarded to LPA, and stored in a file at the facility for the departments review. POC will not be fullfilled until facility demonstrates compliance.

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 observations, the licensee did not comply with the section cited above as LPA observed an unlocked cabinet while conducting a tour of the facility which stored disinfectants, and other cleaning solutions which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/13/2026 Plan of Correction The cabinet was immediately locked and made inaccessible to residents. Completion of an RCFE safety training from an outside provider will be submitted to LPA by Close of Business on 1/13/2026 via email. Training must be completed by all staff.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). 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 the hot water temperature at 134 and 124 degrees Fahrenheit which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/14/2023 Plan of Correction LPA observed Licensee immediately adjust the hot water temperature.

Official classification

Type B

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims No licencee, officer or employee nof a licensee shall make or dissemenate any false or misleading statement regarding the facility or any of the serives provided by the facility. This requirement is not met as evidenced by: 1 out of times the licensee stated that R1 was moving to another facility, and denied the hospital's phone calls, were to assist with a plan R1 back to the facility. This poses a potential heath, safety, and personal rights risk to persons in care.

Official plan of correction

The licensee agrees to make a personal statement of understanding about the importance of providing true and accurate information to the department, The statement is to include the potential risks and consquences of providing misleading/false claims, or statements. Proof is to be submitted to the department by 5pm on the due date indicated.

Deadline recorded: Jun 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition.. residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy..

Official plan of correction

The licensee agrees to have the cameras removed. The cameras were taken down at the conclusion of LPAs visit at approximately 2pm.

Deadline recorded: Jun 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidenced by: Based on observations, the Licensee did not ensure that 1 out of 1 time, the facility was in good repair, as the window was broken in the master bedroom on 5/31/23, leaving jagged and sharp edges exposed, to cut or injur anyone that comes in contact. This is an immediate health risk to residents in care.

Official plan of correction

The licensee agrees to have the window covered up with cardboard until the window can be repaired. In addtion, the licensee agrees to relocate R2 to another bedroom. Proof of correction is to be completed by 6/10/23 by 5pm.

Deadline recorded: Jun 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(20)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities: (a)..residents in privately operated RCFEs shall have all of the following... rights: (20) To be protected from involuntary transfers, discharges, & evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted... & shall comply w/ all eviction & relocation protections...This requirement wasn't met as evidenced by: Based on interview the Licensee didn't ensure R1 was free from an involuntary transfer. Okoro admitted to refusing to allow R1 to return to the facility. This posed a threat to the H & S of R1.

Official plan of correction

The Administrator stated she is refusing to accept R1 back into the facility. When asked for a plan of correction she requested the LPA adise on how to correct. The LPA informed the Administrator the facility has to accept R1 back and follow eviction procedures and properly transfer R1.

Deadline recorded: Jun 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 (a)(1). Incidental Medical and Dental Care. The licensee shall arrange, for medical care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on record review and interviews, the Administrator did not contact emergency medical services for Resident #1 on 6/29/2022 and Resident #2 on July 21, 2022, regarding head injuries.

Official plan of correction

Administrator states that the staff will be retrained on contacting emergency services and providing proper notification. Training documents will be provided. Administrator stated she will provide a written statement regarding her understanding of the regulation.

Deadline recorded: Aug 19, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(D) (a) Each licensee shall furnish a written report within 7 days of the occurrence of any event which threatens the welfare and safety of the resident. This requirement was not met as evidence by: The facility failed to report the incident to CCL within seven days.

Official plan of correction

Administrator stated that the facility shall take immediate action if a future incident occurs. All staff will be trained on reporting to CCL in a timely manner. This will be completed by POC date. Training logs will be provided to LPA upon completion.

Deadline recorded: Aug 8, 2022. 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

Storage Space: (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 was not met as evidenced by: Based on observations, the Licensee did not comply with the above requirement with at least one area of the facility. LPA Colvin observed a bottle of bleach to be propping open the doors for the laundry room and garage. This is an imemdaite safety risk to residents in care.

Official plan of correction

Licensee agrees to remove chemicals from accessiblity of residents. Licensee to tour facility and ensure all potentially hazardous chemicals are locked. Licensee may self-certifiy to LPA Colvin once complete.

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

Official classification

Type A

Official code

87307(a)(2)(a)

Regulation authority

CCR

What the official deficiency says

Personal...Services: (a)...shall be large enough to provide...privacy for the residents...(2) Resident bedrooms shall...at a minimum,...(A) ...be large enough to allow for easy passage between and comfortable usage of...other required items... and any resident assistant devices... This was not met by: Based on interviews and observations, the licensee did not comply with the above regulation with one resident. LPA Colvin observed that R1's bedroom is missing a door and only a curtain is hung to provide some privacy. Licensee states this is due to Hoyer Lift. This is an immedaite personal rights violation of R1.

Official plan of correction

Licensee agrees to do one of the following: Move R1 to a larger room which will accomodate their medical equipment, OR replace the door on R1's room (can be another style of door which is less obstructive to equipment). Licensee to provide plan and proof of correction to LPA Colvin.

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

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

Alterations to Existing Building or New Facilities: (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by: Based on interviews and lack of records, the Licensee did not comply with the above regulation with one room of the facility. LPA Colvin observed an addition to the facility (office/bedroom). Licensee states they do not have proof of building permit. This is a potential safety hazard to staff and residents.

Official plan of correction

Licensee agrees to contact the City Planning Department to ensure the addition is on file and approved. Licensee to also contact County Code Enforecment to have the addition inspected for compliance. Licensee to provide LPA Colvin with approval from City and County agencies for the addition.

Deadline recorded: May 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

Plan of Operation: (a) Each facility shall have and maintain a current, written definitive plan of operation...Any significant changes...shall be submitted to the licensing agency for approval... This requirement was not met by: Based on observation and record review, the Licensee did not comply with the above regulation with one aspect of the Plan of Operation. LPA Colvin observed that the facility sketch did not include the added office/bedroom. This is a potential safety hazard to residents and staff.

Official plan of correction

Licensee agrees to submit udpated Facility Sketch to LPA Colvin, which includes all buildings/rooms and their stated purpose. Plan of Correction due date is 5/24/22.

Deadline recorded: May 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1548(c)(2)(A)

Regulation authority

HSC

What the official deficiency says

Civil penalties;..:(c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation...citation for any of the following serious violations:2) (A) Fire clearance violations, including, but not limited to...inoperable smoke alarms, and inoperable fire alarm systems. This requirement was not met as evidenced by: Based on observation, the Licensee did not comply with the above regulation in at least 3. LPA George obeserved non-operational smoke detectors in various locations: Bedrooms, hallways and common area. This is an immediate safety risk to residents.

Official plan of correction

Licensee agrees to replace all smoke detectors in facility by 5pm on the due date indicated.

Deadline recorded: Dec 21, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care Services: Centrally stored medications shall be kept in a safe locked place that is not accessible to persons other than employees. LPA observed medication in staffs room to be accessible to clients and visitors. Based on observation this requirement is not met as evidenced by the closet being unlocked 1 out of 1 times. This poses an immediated health and safety risk to persons in care.

Official plan of correction

Licensee agrees to provide training to all staff on the importance of keeping all medications locked at all times when not in use. POC is due by 5pm on the due date indicated.

Deadline recorded: Dec 21, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. Based on observation the licensee did not properly store food on 2 out of 2 times. This poses a potential health and saftery risk to persons in care.

Official plan of correction

Licensee agrees to conduct an inservice on proper food storage by the 5 pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(2)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: 2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. Based on interview the licensee did not ensure that resident was checked at least 1 out of 1 time., this poses a potential health, and saftery risk to persons in care.

Official plan of correction

Licensee agrees to have staff document in resident logs that checks and incontinent care has been completed. The POC is due by 5pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569(c)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code section (c) " Care and supervision " means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. Based on interviews the licensee did not assist resident when requested. This poses a potential health, safety or person rights risk to persons in care.

Official plan of correction

The Licensee agrees to conduct an inservice on care and service, as well as review job descritption. Proof is to be submitted by 5pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(4)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by: Based on interview the licensee did not assistance 2 out of 2 residents with their hygiene needs, this poses a potential health safety and personal rights risk to persons in care.

Official plan of correction

Licensee agrees to create a shower log. Proof of correction is to be be submitted to the department by 5pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements: (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: based on observation and interview the licensee did not ensure adequate food supplies on hand at minimum 2 out of 2 times. This poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Licensee agrees to submit receipts according to facility menu posted to ensure the residents are served complete meals. Proof of correction is to be submitted by 5pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements: (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and 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: Based on observation and interview the licensee did not ensure meals of quality and quantity are being served on 1 out of 1 time. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to conduct an inservice on blood borne pathogens Proof of correction is to be submitted by 5pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: This requrement is not met by Licensee having 5 containers full of medication the need to be destoryed. This poses a potential risk to persons in care.

Official plan of correction

Licensee agrees to dispose of medication. Medication destruction record will be submitted to the dept by 5pm on the due date indicated.

Deadline recorded: Jan 4, 2022. A deadline is not proof that correction was completed.