GREEN MERRYLANDS MURRIETA HOME

Official classification

Type B

Official code

87458(c)(1)

Regulation authority

CCR

What the official deficiency says

87458(c)(1) Medical Assessment. 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. (B)Infectious diseases. (C)Contagious diseases. (D)Other medical conditions. This requirement was not met as evidenced by: Based on record review R1s 602A dated 8/21/2025 was incomplete and pages were blank listing no diagnosis or diagnoses.

Official plan of correction

Licensee shall have the physician's report completed in its entirety, Licensee shall submit proof of correction no later than the end of POC date.

Deadline recorded: Jul 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.686(a)(5)

Regulation authority

HSC

What the official deficiency says

1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: (5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. This requirement is not met as evidenced by: Based on LPA Abdoulaye's observation, interview and record review, the licensee did not comply with the section cited above, resulting in the water being shut off, which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee set up a payment plan with the water company and water was restored on 12-04-25.

Deadline recorded: Jan 22, 2026. 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 or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Abdoulaye's observation, interview and record review, the licensee did not comply with the section cited above in fire extinguisher's tag for service is stamped 6/10/2024 which poses an immediate health, safety or personal rights risk to persons in

Official plan of correction

POC Due Date: 11/26/2025 Plan of Correction Licensee will replace expired fire extinguisher by POC due date.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303(c) Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Abdoulaye's observation and interview, the licensee did not comply with the section cited above in two exterior window screens and one door screen have tears which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/24/2025 Plan of Correction Licensee will replace the torn windows and door screens and send an invoice or pictures to LPA by POC due date.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411(d)(3)Personnel Requirements(d)All personnel shall be given on the job training…for the job assigned and as evidenced by safe and effective job performance:(3)Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by: Based on records and interviews, Licensee did not ensure that 1 of 6 staff (S1) had the skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.

Official plan of correction

The licensee confirmed S1 resigned. To prevent recurrence of deficiency, the facility will implement staff training focused on residents' personal rights and the facility's emergency procedures policy. Licensee will email proof of the training conducted with all employees by POC due date. This posed a potential health, safety, and personal rights risk to residents in care.

Deadline recorded: Oct 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

8755(b)(26)

Regulation authority

CCR

What the official deficiency says

87555 General Food ServiceRequirement: (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 evidence by: Based on observation licensee did not ensure there was 7 days of non-perishables and 2 days of perishable food supplies which poses an immediate risk to the health, safety, personal rights of the persons in care.

Official plan of correction

Administrator will provide food supplies for at least 2 days of perishables and 7 days of non-perishables and submit pictures and receipts to the department by 9/30/25.

Deadline recorded: Oct 1, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(d)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: Based observation and interview , the licensee did not comply with the section cited above. The administrator told LPA on the phone that the R1's binder was taken by the paramedics because the facility did not have time to make copies for them

Official plan of correction

Licensee agreed to obtained copies of R1's records and provided copies to LPA by POC due date

Deadline recorded: Jul 25, 2025. 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: Deficient Practice Statement Based on observation the laundry detergent was left unlocked with (1) dementia resident in care. This poses an immediate health, saftey or personal rights risk.

Official plan of correction

POC Due Date: 10/06/2023 Plan of Correction LPA had the staff secure the detergent, the licensee agreed to send the LPA a staff in-service material to conduct with staff, followed by stgaff sign in sheet when it is completed. This will be due on the POC due date.

Official classification

Type B

Official code

87307(d)(4)

Regulation authority

CCR

What the official deficiency says

(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not maintain measures of saftey with ramp that lead to back yard that was falling apart. This poses a potential health safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction The licensee agreed to have this fixed and send proof to the LPA by the POC dued ate.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not have records for the licensee to review for (1) staff member and no staff training on cite. This poses a potential health saftey or personal rights risk.

Official plan of correction

POC Due Date: 10/12/2023 Plan of Correction The licensee agreed to complete the records, send LPA all staff trainings, and send LPA all staff cpr training. Licensee agreed to send file for house manager by the POC due date. The licensee will send a plan on how they will ensure records will be available moving forward.

Official classification

Type A

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function... (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee was utilizing a room as a staff room which is used as a passage way to a bathroom and license resident room. This poses an immediate personal rights, health or safety risk to residents in care.

Official plan of correction

POC Due Date: 10/06/2023 Plan of Correction The licensee agreed to remove the bed and staff belongings from the room. The licensee is to send proof of this by the POC due date.

Official classification

Type A

Official code

87465(i)

Regulation authority

CCR

What the official deficiency says

(i) Prescription medications which are not taken with the resident upon termination of services...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 requirement is not met as evidenced by: Deficient Practice Statement Based on observation the facility has medication that were not destroyed for a prior residents. This poses an immediate health, saftey or personal rights risk.

Official plan of correction

POC Due Date: 10/06/2023 Plan of Correction The licensee agreed to destroy the medications and maintain a destruction record and send to the LPA by the POC due date.