Inspection visit

Routine inspection (multi-day)September 8, 2023

GREEN MERRYLANDSLicense 36188054320 citations on this visit

20 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with staff Sonia Guevara and was granted entry to the facility. The facility is a five (5) bedroom, two (2), bathroom home and, with a kitchen/dining area, living room and attach garage. Licensed capacity is six (6) current census four (4). LPA was accompanied by Staff Sonia Guevara to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, bathrooms were clean. LPA observed sufficient furniture. The hot water temperature tested within regulation at 118 degrees F. The facility is equipped with operating carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. During tour, LPA observed bathroom cabin broken, and medication cabin not locked. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility does not sufficient staff coverage. S1 and S2 had informed LPA their Administrator does not visit their facility. S1 and S2 stated their Administrator operates six (6) other facilities. S2 informed LPA their staff only work for a short period of time and return back to their country. Licensee did not provide an updated LIC 500 and staff schedule. No documents were provided for staff coverage. Facility does not have a designated staff who meets the require qualifications. LPA discovered S1,S2,S3 are able to communicate with residents due to language barrier. Record Review: During record review, Facility did not have three(3) Physician Reports, one (1) admissions Agreement and three (3) pre-admission appraisal. In addition, one (1) LIC621 and five (5) need/services plans missing. No activities are planned and no activities calendar available for residents. Facility did not obtain sufficient information of resident’s dislikes and likes for activities. Licensee failed to develop Infection Control Plan and have a written copy for staff. Furthermore, Licensee did not have Plan of Operation at the facility. During staff record review, Licensee failed to provide the following training for staff: Resident's Bill of Rights, Administration of Medications, Daily Living, and Dementia Special Care. LPA discovered S1 and S2 are not CPR / t 1st aid certificate. During today’s visit, Licensee did not have at least one certified CPR staff on premises. LPA discovered S3 did not have a criminal record clearance. which poses an immediate Health, Safety or personal rights risk to persons in Based on observations today, a civil penalty in the amount of $500 dollars will be issued for no criminal record clearance. The facility will be issued nine (9) type A deficiencies and eleven (11) type B deficiency per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to staff Sonia Guevara, along with a copy of LIC809D, LIC421BG, and the appeal rights.

Citations

20 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.

1569.153(d)Type B
1569.153(d)Theft and loss program; standards, property inventories and surrender of personal effects; secured areas(d) A written resident personal property inventory..This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above evidenced by not having residents' written inventory which poses a potential health, safety or personal rights risk to persons in care.
1569.158(g)(2)Type B
1569.158(g)(2) Family councils(1) If a facility has a family council, the facility shall include.. members.. (2) If a facility does not have a family council, the facility shall provide, upon admission of a new resident, written representative of their right to form a family council. Based on observation and interview the licensee did not comply with the section cited above evidenced by not providing poses a potential health, safety or personal rights risk to persons in care.
1569.267(d)Type B
1569.267(d) Resident's Bill of Rights(d)The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented. This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above evidenced by not providing poses a potential health, safety or personal rights risk to persons in care.
1569.618(a)Type A
1569.618(a)Administration and management of residential care facilities; substituted qualifications; employee scheduling.(a)... operation of the facility when the administrator is temporarily absent from the facility. Based on observation and interview the licensee did not comply with the section cited above evidenced by not having administractor present during working hours which poses an immediate Health, Safety or personal rights risk to persons in care.
1569.618(b)Type A
1569.618(b)Administration and management of residential care facilities; substituted qualifications; employee scheduling.(b).one ..manager..designated substitute qualifications.. responsible designated substitute shall meet..This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above evidenced by not having a designated substitute which poses an immediate Health, Safety or personal rights risk to persons in care.
1569.618(c)(3)Type A
1569.618(c)(3) Administration and management of residential care facilities; substituted qualifications; employee scheduling (c) The facility shall employ..:(3) Ensure that at least one staff member who has (CPR)on the premises at all times..This requirement is not met as evidenced by: Based on observation, interview and reecord review the licensee did not comply with the section cited above by not having at least one staff member on premises at all times who is certified CPR.
1569.69(3)Type A
1569.69 (3) Employees assisting residents with self-administration of medication; training requirements(3) An employee shall be required for hands-on shadowing training. resident in the self-administration of medications... This requirement is not met as evidenced: Based on observation,interview and recrod review the licensee did not comply with the section cited above by not having medication training for staff, which poses a potential health and safety risk to persons in care
87208(a)Type B
87208(a)Plan of Operation(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing.. the license application..This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above evidenced by not providing a copy of facility Plan Of Operation which poses a potential health, safety or personal rights risk to persons in care.
87303(a)Type B
87303(a) Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times... the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above by having bathroom cabin broken and not in good repair which poses a potential health, safety or personal rights risk to persons in care.
87411(d)Type B
87411(d) Personnel Requirements - General(d)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 observation, interview and record review the licensee did not comply with the section cited above evidenced by not providing dementia training and initial training which poses a potential health, safety or personal rights risk to persons in care.
87411(d)(3)Type A
Personnel Requirements - General (d) All personnel shall be given on the job training.. (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 obeservation,interview and record review, the licensee did not comply with the section cited above by not having staff being able to adequately communicate with residents due to lanaguage barrier which poses an immediate Health, Safety or personal rights risk to persons in
87411(g)(1)Type A
87411 Personnel Requirements...(g)prior to employment or initial presence in the facility, all employees and volunteers...shall:(1) Obtain a California clearance...as required by law..This requirement is not met as evidenced by: The Licensee did not obtain a criminal record clearance for Staff #3 (S3) prior to S3 beginning employment or initial presence in the facility. Which poses an immediate health and safety risk to residents in care.
87413(a)(1)Type A
87413(a)(1) Personnel - Operations(a) In each facility:(1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks.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 evidenced by not providing staff coverage when regular staff return from their country
87458(a)Type A
87458(a) Medical Assessment(a)Prior to a person's acceptance as a resident, .. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment.This requirement is not met as evidenced: Based on observation,interview and recrod review the licensee did not comply with the section cited above by not having three(3)physician reports, which poses a potiential health and safety risk to persons in care
87462Type B
87462 Social FactorsThe facility shall obtain sufficient information about each person's likes and dislikes and interests and activities..suggest the program of activities in which the individual may wish to participate. This requirement is not met as evidence by: Based on observation and interview the licensee did not comply with the section cited above evidenced by not obtaining information dislikes and likes activites which poses a potential health, safety or personal rights risk to persons in care.
87465(h)(2)Type A
87465(h)(2)Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in centrally stored medication.This requirement is not met as evidenced by: Based on observation, interview and record review the licnesee did not comply with the section cited above by having the centrally stored medication cabinet accessible to residents which poses an immediate Health, Safety or personal rights risk to persons in care.
87470(c)Type B
87470(c) Infection Control Requirements(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208.This requirement is not met as evidenced by Based on observation and interview the licensee did not comply with the section cited above evidenced by creating An Infection Control Plan which poses a potential health, safety or personal rights risk to persons in care.
87506(b)(15)Type B
87506(b)(15)Resident Records(b) Each resident’s record shall contain at least the following information:(15)The.. Admission Agreements and 87457, Pre-admission Appraisal... This requirement is not met as evidenced by: Based on observation,interview and recrod review the licensee did not comply with the section cited above by not having three(3) admission agreements, which poses a potiential health and safety risk to persons in care
87507(a)Type B
87507(a) Admission Agreements(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement is not met as evidenced by: Based on observation,interview and recrod review the licensee did not comply with the section cited above by not having one(1) admission agreements, which poses a potiential health and safety risk to persons in care
87707(1)Type B
87707(1) Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments(1) Direct care staff shall complete six hours of orientation specific to the care of ..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 evidenced by not providing dementia training and initial training which poses a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the September 8, 2023 inspection of GREEN MERRYLANDS?

This was a other inspection of GREEN MERRYLANDS on September 8, 2023. 20 citations were issued: 9 Type A (serious) and 11 Type B.

Were any citations issued to GREEN MERRYLANDS on September 8, 2023?

Yes, 20 citations were issued (9 Type A, 11 Type B). The first citation was for: "1569.153(d)Theft and loss program; standards, property inventories and surrender of personal effects; secured areas(d) A..."

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 CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

Routine inspection (multi-day)·September 8, 2023