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Inspection visit

Routine inspection (multi-day)

GOLDEN LEAF MANORLicense 1976063066 citations on this visit
6 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analysts (LPA) Jose Villalobos conducted an Case Management - Annual Continuation using the full Care Compliance and Regulatory Enforcement (CARE) Tools to complete the yearly annual for the facility. LPA met with Licensee Percy Olidan and the purpose of the visit was discussed. The following is the remaining (9) of (12) (CARE) tool domains completed during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed Operational Requirements: A current Plan of Operation observed. Dementia Care Plan Observed A fire clearance for 6 residents of which (6) may be non ambulatory Hospice care waiver approved for up to one (1) resident. Personnel Records - Staff Training: Administrator on file is not current and is currently expired. Staff have criminal background clearances. Four (4) staff files were reviewed. Staff #1 Requires training Staffing: Sufficient staff observed during visit Resident Records - Incident Reports: A total of one (1) resident file were reviewed. Continued on LIC 809-C Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities supply observed Incident Medical and Dental: Emergency transportation available First Aid Kid observed (1) of (1) Resident medications reviewed Disaster Preparedness: Emergency and Disaster Plan observed but is outdated. Last Emergency Drill conducted longer than 3 months ago Residents with Special Health Needs: Needs and Services Plans are on file. Currently (0) residents receiving hospice services. Inspection Tool was completed and per Title 22 deficiencies are being cited on todays visit. See 809-D pages attached Exit interview conducted. Copy of this report and appeal rights were discussed and provided.

Citations

6 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.605Type B

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the licensee could not provide a copy of their insurance at the time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 1569.626(a)Type B

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as staff Jocelyne Serra does not have proof of trainings completed on file which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 1569.695(a)Type B

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the emergency disaster plan is not updated to the curent form for the LIC 610D which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 1569.695(c)Type B

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as there is no record on file of last emergency drill completed which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87412(a)(13)(B)1Type B

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as Administrator certificates are expired, which poses/posed a potential health, safety or personal rights risk to persons in care.

  • 87465(a)(6)Type A

    Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as several medications have not been ordered from the pharmacy and added to the centrally stored medications list for resident #1, which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the December 26, 2023 inspection of GOLDEN LEAF MANOR?

This was a other inspection of GOLDEN LEAF MANOR on December 26, 2023. 6 citations were issued: 1 Type A (serious) and 5 Type B.

Were any citations issued to GOLDEN LEAF MANOR on December 26, 2023?

Yes, 6 citations were issued (1 Type A, 5 Type B). The first citation was for: "Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the li..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.