Green Pines Residential Care Home

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management. LPA met with facility Licensee Paul Lumbi, and explained the purpose of today's visit. The purpose of today’s inspection is to follow up on the facility’s voluntary closure and surrendering of license. Licensee stated they no longer have access to the facility residence as the landlord has taken back the keys and is remodeling the residence. LPA toured the facility and observed no residents currently living at this location. Facility closure will be processed upon LPA Hurt return to the office. Licensee Paul stated he cannot surrender the official license as he is not sure where it went and he believes it might have been packed in some of the moving boxes. No deficiencies cited Per title 22 regulations. Exit interview conducted with Licensee Paul Lumbi, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management. LPA met with facility Licensee Paul Lumbi, and explained the purpose of today's visit. LPA provided letter notifying of planned online Informal Office Meeting to take place on 10/27/2025 at 11:30 a.m. on Microsoft teams. Licensee notified LPA of plan to close the facility on November 20, 2025. LPA requested Licensee bring facility closure plan and closure letters provided to facility residents to the Informal Office Meeting on 10/27/2025. No deficiencies cited Per Title 22 Regulations. Exit interview conducted with facility Licensee Paul Lumbi, and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 15, 2025

Allegation investigated: Staff refused to accept the resident back to the facility

On 08/12/2025, Licensing Program Analyst (LPA) Sarah Hurt arrived to the facility unannounced to deliver findings on the above allegation. LPA met with Licensee Paul Lumbi via telephone and stated the purpose of the visit. Regarding the allegation Staff refused to accept the resident back to the facility. Resident 1 is not and has never been a resident of this facility. Based on the information received, we have found that the complaint is Unfounded, meaning that the allegation is false, could not have happened, and/or is without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted over the phone with Licensee Paul Lumbi. A copy of this report was provided at the time of visit. Nothe state’s words, verbatim · CDSS document, Aug 12, 2025 · control 24-AS-20250805080503

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sarah Hurt arrived unannounced to conduct a Case Management visit on 08/12/2025. LPA met with facility Licensee Paul Lumbi, and stated the purpose of the visit. LPA Hurt observed the facility smells like urine. Licensee was hospitalized and stated his son and daughter were both assisting with the facility while they were hospitalized. Licensee's son is not qualified to care for residents or fingerprint cleared to be inside the facility. The following cited or observed today. Exit interview conducted with Licensee, Paul Lumbi, and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 12, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 26, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: Based on observation the facility smells strongly of urine, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Licensee stated he will have staff come to clean the carpets and submit proof to Licensing by 08/26/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Aug 26, 2025

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. The following requirement has not been met as evidenced by: Licensee stated his son and daughter are assisting while he was hospitalized, Licensees son is not qualified to care for residents and is not fingerprint cleared, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2025

Plan of correction: Licensee will submit LIC308 to LPA by POC date of 08/26/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee Paul Lumbi, Continual Administrator's Certification is expired. Licensee Paul is on the list of pending Administrators certificates with 09/2023 as date of application. There are currently 5 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. Water temperature was tested at 115 degrees. Toxins and cleaning supplies are locked and inaccessible. Facility first aid kit is on site and complete. The facility has no 610E Emergency Disaster Plan, facility has no current Infection Control Plan. Resident 1 has no Physicians Report, or Pre Admission Assessment. LPA Hurt observed several small bugs inside facility restroom on walls, and bathroom vanity. LPA Hurt observed cobwebs with spiders throughout facility. Resident 2's medication is not logged on Centrally Stored Medication Record. Facility is not conducting required quarterly disaster drills. Staff 1 does not have LIC 503 Health Screening Report on file. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Licensee, Paul Lumbi and copy of report along with appeals rights left at facilitythe state’s words, verbatim · CDSS document, Oct 24, 2024