Green Meadows Board and Care 11

Type of visit: Required - 1 Year

On 10/22/2025 at 10:15 AM, Licensing Program Analyst LPA) Jose Calderon conducted an unannounced annual inspection visit at the Green Meadows Home 2 Facility. LPA Calderon was allowed entry into the facility by Staff Bernadette Banks. The facility is licensed to operate for six (6) ambulatory adults ages 59 and above. Currently, there are four (4) residents residing in the facility, between the ages of 59 and above with cognitive issues. LPA Calderon explained to Staff Banks the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Four (4) client service records, four (4) client medication records (MAR), two (2) staff records, and inspected the inside facility and outside grounds. LPA Calderon interviewed four (4) clients and two (2) staff members for visit. The facilities’ last fire drill was conducted on 10/12/2025. The one-story residential home consists of four (4) client bedrooms, two (2) client bathrooms, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored on the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage and kitchen area. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of client’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature was properly measured at 108 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 108 degrees Fahrenheit. Kitchen hot water temperature properly measured at 110 degrees Fahrenheit. Facility (2) Carbon Monoxide and (5) Smoke Detectors battery operated and connected were tested and are working properly. The facility one (1) Fire Extinguishers was checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. The facility has a working landline telephone. All toxins and knives are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked storage cabinet. Facility 2 first aid kit is fully stocked with manuals checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to clients. Four (4) client files were reviewed and found to be complete. LPA Calderon reviewed four (4) resident medications (MAR) and they were all found to be administered according to doctor's orders. Two (2) staff files were checked and have the required documents. LPA Calderon noted the Administrator Elena Castillo Certification # 707388740 expiration date of 02/20/2027 was valid at time of inspection. Commercial General Liability Policy #001296933 policy period from 04/07/2025 to 04/07/2026 underwritten by James River Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. All the required documents are posted in the facility in a clearly visible area. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT. An exit interview was conducted, and a copy of the Facility Evaluation report was provided to staff Bernadette Banks.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Required - 1 Year

On 11/20/2024 at 11:30 AM, Licensing Program Analyst LPA Jose Calderon conducted an unannounced annual inspection visit at the Green Meadows Board and Care II Facility. LPA Calderon was allowed entry into the facility by Administrator Ellen Castillo. Administrator Castillo asked infection control questions and took LPA Calderon temperature prior to entering the facility. The facility is licensed to operate for six (6) non-ambulatory residents ages 60 and above. Currently, there are five (5) residents residing in the facility, between the age of 60 and above. LPA Calderon explained to Administrator Castillo, the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Five (5) resident service records, five (5) resident medication records (MAR), two (2) staff records, and inspected the inside facility and outside grounds. LPA Calderon interviewed five (5) residents and two (2) staff members for visit. The facilities’ last fire drill was conducted on 11/12/2024. The one-story residential home consists of five (5) resident bedrooms, two (2) resident bathrooms, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored or found on the premise grounds. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the garage. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of client’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 117 degrees Fahrenheit; bathroom #2 hot water temperature properly measured at 120 degrees Fahrenheit. Kitchen hot water temperature properly measured at 117 degrees Fahrenheit. Facility two (2) Carbon Monoxide and seven (7) Smoke Detectors hard wired and connected were tested and are working properly. The facility two (2) Fire Extinguisher was checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. The facility has a working landline telephone. All toxins and knifes are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked storage cabinet. Facility two (2) first aid kits is fully stocked with manuals was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to clients. Five (5) resident files were reviewed and found to be complete. LPA Calderon reviewed five (5) resident medications (MAR) and they were all found to be administered according to doctor's orders. Two (2) staff files were checked and have the required documents. LPA Calderon noted the Administrator Ellen Castillo Certification # 7007388740 expiration date of 02/20/2025 was valid at time of inspection. The facility does not handle client's money/cash resources and no Surety bond is needed. Commercial General Liability Policy #ADMINISTRATOR COULD NOT PRODUCE INSURANCE PAPERWORK AT THIS TIME. Administrator Ellen Castillo to email LPA Calderon a full copy of the commercial insurance policy including all endorsements no later than 11/22/2024. All the required documents are posted in the facility in a clearly visible area. During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and clients, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and clients were NOT wearing face coverings. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA Calderon advised the Administrator Ellen Castillo to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Ellen Castillo.the state’s words, verbatim · CDSS document, Nov 20, 2024

Type of visit: Required - 1 Year

On 12/17/23, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA was met by caregivers Carmencita Yap and Radmar Vistar and explained the purpose of today’s visit. Later was joined with Noemie Bunag. The facility is licensed to serve six (6) elderly residents ages 60 and above. The facility has a hospice waiver for one (1) resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, one (1) staff room, two (2) bathrooms, living area, dining area, kitchen, and outside shaded patio area. All four (4) residents were in the facility at the time of the visit and zero (0) on hospice care. LPA Richard and caregiver Radmar Vistar toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were operational. The water hot water temperature tested 107. 2F and 106. 5F. There is an attached garage accessible through the door prior to entering the facility or the front of the garage. There is also a refrigerator/freezer located in the back patio area for additional food storage. The washer and dryer are located in the garage next to the water heater. Evaluation Report Continues on LIC 809-C LPA observed the facility to be appropriately furnished at the time of visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available and properly maintained. There are two (2) fire extinguishers fully charged with one in the garage and the other in the kitchen area. Smoke detectors and carbon monoxide were tested and operational. A review of Medication Administration Records (MAR) was maintained in order and accurate. There was a first aid kit available stored in the kitchen. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed all mandated inspection control posters were posted. There were two (2) deficiencies cited during this inspection visit. An exit interview was conducted and a copy of this report and appeal rights were provided to administrator Noemie Bunagthe state’s words, verbatim · CDSS document, Dec 17, 2023