Green Life Care Facility Inc

1569.10 RCFE; license or permit; necessity No person, firm, partnership, association, or corporation within the state.....without a current valid license or current valid special permit...This requirement is not met as evidenced by: Based on interviews conducted, LPA was informed that R1, R2, R3, were receiving elements of care and supervision, which posed an immediate health and safety risk or personal rights risk to residents in care.

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training...This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in not having a valid CPR/first aid training for a the staff available at the shift which poses/posed a potential health, safety or personal rights risk to persons in care.

Requirements(a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to ... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and review of the hospital discharge records conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalizations on 10/07/25 and 10/22/25, which poses a potential health and safety risk to persons in care.

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in having bedroom #3 emergency exit, activity room exit and main exit blocked by a trash can, a basket, and a dog which poses/posed a potential health, safety or personal rights risk to persons in care.

(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 .... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in having all cleaning supplies, laundry detergents, a scissor, and knives unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

(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:This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above in one (1) out of two (2) staff (S2) working without a proper fingerprint cleareance which poses an immediate health, safety or personal rights risk to persons in care.

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working,....a licensed facility: (3) Request a transfer of a criminal record....in Section 87355(c) or This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above in one (1) out of two (2) staff members (S1) not being associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.

(g) All personnel records shall be maintained at the facility.This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in two (2) out of two (2) staff files not maintained at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnose......for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in three (3) out of three (3) residents did not have any records of TB test results which poses/posed a potential health, safety or personal rights risk to persons in care.

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible.........This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in all the residents and staff medications were accessible in the kitchen drawer, staff room, and bedroom #3 (resident) which poses an immediate health, safety or personal rights risk to persons in care.

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in three (3) out of three (3) residents files/records not available for audit at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

(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.....: This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in two (2) out of two (2) staff files not available to LPA for audit and review which poses/posed a potential health, safety or personal rights risk to persons in care.

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated...... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in not having a proper designee at the facility who can assist with LPA to provide documents

Based on observation and interview, the licensee did not comply with the section cited above in not having a proper designee at the facility who can assist with LPA to provide documents for residents and staff upon request which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in three (3) out of three (3) residents did not have any records of TB test results which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in all the residents and staff medications were accessible in the kitchen drawer, staff room, and bedroom #3 (resident) which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in three (3) out of three (3) residents files/records not available for audit at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in having a half bedrail for a resident without a Physician order on file, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in two (2) out of two (2) staff files not available to LPA for audit and review which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in not having a valid CPR/first aid training for a the staff available at the shift which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interviews and review of the hospital discharge records conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalizations on 10/07/25 and 10/22/25, which poses a potential health and safety risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in not maintaining the appropriate water tempreture from 105 to 120 F degress which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in having bedroom #3 emergency exit, activity room exit and main exit blocked by a trash can, a basket, and a dog which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in having all cleaning supplies, laundry detergents, a scissor, and knives unlocked and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview and record review, the licensee did not comply with the section cited above in one (1) out of two (2) staff (S2) working without a proper fingerprint cleareance which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in one (1) out of two (2) staff members (S1) not being associated with the facility which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in two (2) out of two (2) staff files not maintained at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interview the Licensee did not provide personnel records/files of the Administrator and one staff to the LPA for review which poses a potential health and safety risk to residents in care.

Based on record review of the Community Care LIcensing Department, the licensee did not comply with the section cited above. S1's first day of work was on 04/20/2024 and as of 01/16/2025 S1 is not associated to the facility which poses an immediate health, safety risk to persons in care.

Based on interviews conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's death on or before 06/01/24, which poses a potential health and safety risk to persons in care.

Based on interview, the licensee did not comply with the section cited above by failing to obtain/maintain liability insurance as required which poses a potential health, safety, and personal rights risk to persons in care.

Based oninterview, the licensee did not comply with the section cited above by not providing R1's records/file to the LPA for review which poses/posed a potential health, safety or personal rights risk to persons in care.