GREEN FIELD HAVEN

Official classification

Type A

Official code

1569.312(d)

Regulation authority

HSC

What the official deficiency says

1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidenced by: based on file review, licensee did not comply as R1 left the facility unassisted which poses an immediate health and safety risk fro residents in care.

Official plan of correction

Licensee is to submit a plan of how facility will ensure R1 will not wander outside of the facility unassisted. Plan of correction is due to LPA by Friday August 21, 2026.

Deadline recorded: Aug 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General. All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement is not met as evidenced by: Based on LPA's record review, staff did not have training for 2025 and 2026. This does not pose an immediate risk to residents.

Official plan of correction

By 05/08/2026, Licensee shall submit a written plan of correction how she shall ensure staff have continuing annual training per the regulations.

Deadline recorded: May 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

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) Obtain a California clearance or a criminal record exemption as required by the Department or Based on observation and file review, Licensee did not comply as T1 has an " in process " status on clearance which poses a potential risk for residents in care.

Official plan of correction

T1 requires care and supervision and will not leave the facility. Licensee is to contact CPMB for updates on T1's clearance. Updates are to be provided to LPA as needed.

Deadline recorded: Apr 11, 2025. 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 record review, the licensee did not comply with the section cited above in 2 out of 2 staff files being incomplete with annual training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/04/2024 Plan of Correction Licensee will conduct an annual training with staff by the POC due date and submit to LPA Ratajczak a list of topics covered as well as staff signatures indicating which staff has completed the training.

Official classification

Type B

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidence by: During inspection conducted by CCLD on 3/14/2022, LPA observed staff not wearing face masks while inside the facility, which poses an potential health, safety, and personal rights risk to the residents in care.

Deadline recorded: Mar 28, 2022. A deadline is not proof that correction was completed.