Greenpark Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Gladys Pervez, administrator who assisted with the visit. The facility is licensed to serve one (1) bedridden and five (5) non-ambulatory residents (ages 60 and above). The facility has an approved five (5) Hospice Waivers. Currently, there are five (5) residents in placement including three (3) hospice residents. Annual licensing fees are current. Administrator certificate is current and the expiration date is 02/08/25. During the visit, the CARE tool was used, facility was toured, staff/residents were interviewed, staff/residents records were reviewed, food supply was reviewed, and medications were reviewed. The facility is located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. LPA observed the facility to have four (4) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, garage equipped with a laundry area and an indoor/outdoor activity area. No pools and bodies of water on the premises. All residents' bedrooms and bathrooms had appropriate furnishing and in compliance. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 118.9 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. Auditory alarm devices to monitor exits were operable. Last fire drill was conducted on 08/08/23. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers’ last service is on 6/6/23 and are fully charged. Mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication is centrally stored in a locked cabinet; resident records are stored in a locked room and both inaccessible to residents. Toxic substances are inaccessible to residents. Outdoor facility space for residents' leisure are completely enclosed by a fence with self-closing gates. No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez's signature on this form confirmed receipt of these documents. A copy of LIC 809 report was provided.the state’s words, verbatim · CDSS document, Sep 11, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Gladys Pervez who assisted with visit. The facility is licensed to serve one (1) bedridden and five (5) non-ambulatory residents (ages 60 and above). The facility has an approved Hospice Waiver for five (5) residents. Currently, there are six (6) residents in placement including three (3) hospice residents. Annual licensing fees are current. Administrator certificate is current and the expiration date is 02/08/23. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. LPA observed the facility to have four (4) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, garage equipped with a laundry area and an indoor/outdoor activity area. All the rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was 119.0 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Interior and exterior space available to permit residents to wander freely and safely. Last fire drill was conducted on 8/30/22. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers’ last service is 3/10/22 and are fully charged. (-continued in LIC 809C-) The first aid kit is fully stocked. Mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication is centrally stored in a locked cabinet in med room and inaccessible to residents. Resident records are stored and locked in med room, inaccessible to residents. Toxic substances are inaccessible to residents. Outdoor facility space used for residents and leisure are completely enclosed by a fence with self-closing gates. No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Gladys Pervez's signature on this form confirmed receipt of these documents. A copy of LIC 809s report was provided.the state’s words, verbatim · CDSS document, Sep 12, 2022

Type of visit: Required - 1 Year

On 8/25/21 at 12:45 p.m. Licensing Program Analysts Nina Galarza and Nune Margaryan arrived at the facility to conduct an unnanounced annual visit. LPAs met with Teresita Roda and later met with administrator Gladys Pervez and stated the purpose of the visit. LPAs observed COVID informational, hand washing protocol postings outside the facility and throughout the facility. LPAs were screened for COVID symptoms and temperature was taken by staff. The facility is licensed to serve one (1) Bedridden and five (5) Non-Ambulatory residents (ages 60 and above). The facility has an approved Hospice Waiver for two residents on file. Currently, there are six (6) residents in placement. The facility is a single story home located in a residential neighborhood. LPA observed the facility to have four (4) resident bedrooms, 2 bathrooms, living room, dining room, kitchen, garage equipped with a laundry area and an indoor/outdoor activity area. Bathrooms are clean and operational with grab bars and non-skid surface mats in place. The hot water temperature measured at 114 degrees Fahrenheit and 117.2 degrees Fahrenheit. Adequate linen and personal hygiene supplies. LPAs observed 2 days worth of perishable and 7 days worth of nonperishable foods for all clients. Smoke and carbon monoxide detectors are dual/hardwired and operable. All mandated documents are posted in a prominent place. The outdoor activity area is free of visible hazards and debris. There is shaded patio areas with ample seating in the rear. The trash cans have covered lids. Staff and resident records have required documentation. All exit doors are equipped with auditory device alarms. CONTINUED 809-C The following deficiencies were observed at time of visit: R1 was prescribed Purelax powder, 1 Capful as needed, but was not listed on residents Medication Administration Record (MAR) R2 was missing Bezonate, 100 mg; 1-2 cups for cough. R3 medication was not labeled for; Acetaminophen 325 mg, Milk of Magnesia, Aspirin 81 mg, and Antacid Liquid R4 medication was not labeled; Melatonin 10 mg Deficiencies cited per California Code of Regulations. Exit interview conducted, a copy of appeal rights and report given to administrator.the state’s words, verbatim · CDSS document, Aug 25, 2021