Inspection visit

Routine inspectionAugust 7, 2024

GREEN MERRYLANDSLicense 36188054321 citations on this visit

21 citations recorded

Inspector’s narrative

What the inspector wrote

On 08/07/2024 at 08:45 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection.LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. Vicente Picache Arambula reported to LPA Brown that Administrator Brandon Marquez was not at the facility. LPA Brown contacted Administrator Marquez and informed of the visit but call was not answered. LPA Brown explained the purpose of the visit to Vicente Picache Arambula. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has two (2) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Vicente Picache Arambula 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 Division (CCLD). LPA Brown observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space. However, LPA Brown did not observed lamps and chairs. Technical Violation issued. Also, LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. Furthermore, during the tour of the facility, LPA Brown was denied access of the Administrator Office for spot inspection. Deficiency will be issued. LPA Brown observed movable bins used for storage of solid wastes outside the facility in disrepair. Deficiency will be issued.LPA Brown observed movable bins used for storing or transporting solid wastes from the premises does not have cover inside the facility. Deficiency will be issued. LPA Brown observed no chair and lamp on all resident bedrooms. Technical Violation will be issued. ***Continuation in LIC809C *** Incomplete Emergency Kit observed at the facility. Deficiency will be issued. L PA Brown observed no first aid manual approved by the American Red Cross, The American Medical Association or a state or federal health agency. Deficiency will be issued. Record Review : LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA Brown observed that Resident #2 (R2) and Resident #3 (R3) Admission Agreement do not have facility representative signature. Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown observed that no on-the-job training provided for Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4), also, no documented Residential Care for the Elderly (RCFE) and Dementia, Postural Supports, Hospice Care trainings for S3 and S4. Deficiencies will be issued. During medication audit, LPA Brown observed that one (1) of R3's medication was given to R3 but per Medication Administration Records (MAR) review, it does not show that R3's medication was given per physician's direction. Also, LPA Brown observed one (1) of R3's medication was not given to R3 due to no refill available at the facility since 08/03/2024, two (2) of R3's medication were not given to R3 due to no refill at the facility since 08/04/2024 and one (1) medication was not given to R3 due to no refill at the facility since 08/06/2024. Deficiency will be issued. LPA Brown observed no activity program for the residents at the facility. Defiency will be issued. In addition, LPA Brown observed that no Administrator present at the facility during working hours as required and LPA Brown contacted Administrator Marquez and Licensee Zhao. Deficiency will be issued. Deficiency will be issued. Per records review, the facility were cited for the same regulations within 12-month period for CCR 87309(a)(1) and 87608(a)(5)(B) civil penalty will be issued today, 08/07/2024 with the amount of $250.00 per repeat violation. Also, the facility will be issued immediate civil penalty for repeat violation of $1000.00 for HSC Section 1569.618(a) for third offense within 12-month period. An exit interview was conducted where this report, LIC809, LIC809D, LIC421FC, LIC421IM, LIC9102TV, LIC9102, and Appeal Rights were discussed and provided to Vicente Picache Arambula. ***This is an amended copy of LIC809C issued on 08/07/2024*** LPA Brown observed no nightlight maintained in hallways and passages to nonprivate bathrooms. Deficiency will be issued. LPA Brown observed the outdoor passageways not free of obstructions. Deficiency will be issued. To add to that, LPA Brown observed Resident #1 (R1) with full bed rails and Vicente Picache Arambula reported to LPA Brown that R1 is not on Hospice Care and per records review, no written order from R1's physician was observed indicating the need for postural support/full bed rail. Also, LPA Brown observed,no exception letter submitted and approved by Community Care Licensing Division (CCLD) for R1's full bed rail. Deficiency will be issued. To add to that, LPA Brown observed Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4) have half bed rails. Vicente Picache Arambula reported to LPA Brown that R2, R3, and R4 don’t have written order from their physician indicating the need for half bed rail for mobility. Deficiency will be issued. Moreover, during the tour of the facility, LPA Brown observed one (1) screw driver, two gallons of laundry detergent in the laundry area not locked and accessible to resident in care. Deficiency will be issued. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the bathroom to be at 116 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Furthermore, during the tour of the facility, LPA Brown observed broken screens, metal wires, carpets, boxes in an unlocked kitchen drawer, accessible to residents in care. Deficiency will be issued. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication cabinet. Food Service : Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision : The facility does not have an administrator present in the facility. LPA Brown observed no sufficient number of staff to provide care and supervision to the residents in care as no staff scheduled to work at night as required for facility with dementia residents. Deficiency will be issued. ***Continuation in LIC809C ***

Citations

21 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.

1569.32Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by denying LPA Brown access to the Administrator Office during the facility Inspection which poses a potential health, safety or personal rights risk to persons in care.
1569.618(a)Type A
Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that the facility has an Administrator during normal working hours as required which poses an immediate health, safety or personal rights risk to persons in care.
1569.625(b)(1)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Staff #3 (S3) and Staff #4 (S4) complete the required Residential Care for the Elderly (RCFE) 40 hours of training which poses an immediate health, safety or personal rights risk to persons in care.
1569.625(b)(2)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Staff #3 (S3) and Staff #4 (S4) completed the required dementia training annually which poses an immediate health, safety or personal rights risk to persons in care.
1569.626(a)Type A
Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that Staff #3 (S3) and Staff #4 (S4) at the facility completed the required dementia training which poses an immediate health, safety or personal rights risk to persons in care.
1569.696(a)Type A
Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that Staff #3 and Staff #4 completed the required postural supports, restricted conditions or health services, and hospice care training which poses an immediate health, safety or personal rights risk to persons in care.
87303(f)(3)Type B
Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that the container used for storage of solid waste is in good repair which poses a potential health, safety or personal rights risk to persons in care.
87303(f)(4)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that teh movable bin used for storing solid wastes does not have cover which poses a potential health, safety or personal rights risk to persons in care.
87307(d)(5)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that nightlights are maintained in hallways and passages to nonprivate bathrooms which poses a potential health, safety or personal rights risk to persons in care.
87307(d)(6)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the outdoor passageway is kept free of obstruction which poses a potential health, safety or personal rights risk to persons in care.
87309(a)(1)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited aboveby not ensuring that one (1) screwdriver and two (2) gallons of laundry detergent in the laundry room, are locked and not accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.
87411(d)Type A
Based on observation, interview, record review, the licensee did not comply with the section cited above by not having the required on the job training and/or related experience in the job for Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4) which poses an immediate health, safety or personal rights risk to persons in care.
87470(c)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by not developing the required Infection Control Plan for the Facility which poses a potential health, safety or personal rights risk to persons in care.
87507(c)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Resident #2 (R2) and Resident #3 (R3) Admission Agreement were signed by the facility representativewhich poses a potential health, safety or personal rights risk to persons in care.
87608(a)(5)(A)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by allowing Resident #2 (R2), Resident #3 (R3) and Resident #4 (R4) to have half bed rail and not ensuring that they have written order from their physician indicating the need for half bed rail for mobilitywhich poses a potential health, safety or personal rights risk to persons in care.
87608(a)(5)(B)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited above by allowing Resident #1 (R1) to have full bed rail but per records review, R1 is not on hospice and exception report submitted to licensing for approval for full bed rail which poses an immediate health, safety or personal rights risk to persons in care.
87705(c)(4)(A)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that there's a staff scheduled to work the night shift, awake and on duty as required for facility with dementia residents which poses an immediate health, safety or personal rights risk to persons in care.
87705(c)(7)Type B
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that there's an activity program that address the needs and limitations of residents with dementia and include large motor activities and perceptual and sensory stimulation which poses a potential health, safety or personal rights risk to persons in care.
87465(a)(8)Type A
Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that the facility has a complete supply of first aid kit which poses an immediate health, safety or personal rights risk to persons in care.
87465(a)(8)(A)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the facility has a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency which poses an immediate health, safety or personal rights risk to persons in care.
87465(c)(2)Type A
Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Resident #3 (R3) medications were given per R3 physicians's order as evidenced of one (1) of R3's medication was given to R3 but per Medication Administration Records (MAR) review, it does not show that R3's medication was given per physician's direction. Also, LPA Brown observed one (1) of R3's medication was not given to R3 due to no refill available at the facility since 08/03/2024, two (2) of R3's medication were not given to R3 due to no refill at the facility since 08/04/2024 and one (1) medication was not given to R3 due to no refill at the facility since 08/06/2024. This incidents poses an immediate health, safety or personal rights risk to persons in care.
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FAQ · About this visit

Common questions about this visit

What happened during the August 7, 2024 inspection of GREEN MERRYLANDS?

This was a inspection inspection of GREEN MERRYLANDS on August 7, 2024. 21 citations were issued: 12 Type A (serious) and 9 Type B.

Were any citations issued to GREEN MERRYLANDS on August 7, 2024?

Yes, 21 citations were issued (12 Type A, 9 Type B). The first citation was for: "Based on observation, interview and record review, the licensee did not comply with the section cited above by denying L..."

What type of inspection was this?

This was a inspection inspection. inspection 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·August 7, 2024