Green Willow Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst, LaVette Farlow, (LPA) arrived at the Green Willow Home Care Facility unannounced to conduct the Annual Inspection. LPA knocked on the door and was greeted by Care Staff, Cecilia Plagata and granted entry. LPA introduced self and stated purpose of the visit. Administrator, Arminda Lopez was notified of my arrival by Care Staff, Miguelito Veluz. LPA was accompanied by Miguelito Veluz and Cecilia Plagate during the tour of the inside and outside, and observed the following: Facility: The Facility is licensed for six (6) non-ambulatory adults, 1 bedridden and a Hospice Waiver for 6 residents. LPA observed that the facility is operating in the capacity and conditions approved by Community Care Licensing (CCL). Physical Plant: LPA Farlow observed the facility's temperatures to be maintained comfortable temperature. The facility is comprised of 2 Living Rooms, Dining Rooms, Resident/Staff Rooms, Bathrooms, Kitchen, Backyard and attached garage. Resident Room contained all required furnishings. Restrooms are maintained for staff and residents. Each bathrooms included operable appliances, adequate paper supplies, non-slip grip materials and handrails. Extra supplies of linens, towels, hygiene supplies were located in the bathroom and some in the garage. The facility was sufficiently lit by various lamps and night lights throughout the facility. The facility is equipped with operable fire/smoke alarms, carbon monoxide detectors. Fire Extinguisher was located in the kitchen; and last inspected January 2024. Staff Miguelito, stated the fire department was here in January 2025 and adjusted the mounting of the fire extinguisher on the wall. Licensee will provide proof of service. The facility's Emergency Disaster Plan, Facility Sketch and Evacuation Plan was reviewed; as it was posted in a prominent place. LPA observed the emergency or disaster plan had not been reviewed and signed since 2/16/2023. Kitchen/Food Service: LPA observed the food supply; the amount of perishable food is sufficient for number of residents in care. The nonperishable and can good is not sufficient for resident in care. A technical violation issued. LPA's visit was during dinner. LPA witnessed food prepared and stored properly. Sharp objects were secure and inaccessible to residents in care. Please see LIC809-C Garage - In the facility's attached garage, LPA observed the emergency food supply was well stocked. LPA also observed that the facility centrally stores medications securely in this area. Care & Supervision: Facility has sufficient care staff; who also reside on facility grounds. toxic items are inaccessible to residents in care and stored and locked in a filing cabinet in the office. Record Review of Resident/Staff Files: LPA reviewed records for two (2) residents in care. Resident records are all complete with updated Physician's Reports, Admissions Agreements, Appraisals and Needs and Services Plans. LPA reviewed 4 (four) out of 4 four (4) staff files. LPA observed that three (3) of the staff records reflect current CPR/First Aid Certification, Personnel Records and Health Screenings. LPA observed the two (2) out of two (2) staff was not Criminal Record Cleared and or fingerprinted. A deficiency was cited and civil penalties will be assessed. The Administrator's Administrator Certificates were posted and observed in good standing. Signs/Posters: LPA observed the following signs posted in a prominent place: Facility Sketch Disaster Plan, Long Term Care Ombudsman, Resident Rights, Resident Council, Theft and Loss Policy, Staff Roster, Visiting Hours, Daily Schedule and facility license are posted in the hallway of the facility. Emergency or Disaster Plan was posted, but had not been reviewed and signed since 2/2023. A technical violation issued. Medication/Medical Related Services: LPA observed that the resident's medications are centrally stored and secure in file cabinets in the kitchen and garage. LPA reviewed 2 out of 2 resident's medications and compared it to the facility's Medication Administration Report (MARS) and Centrally Stored Medication Log. LPA found 1 out of 2 residents MARS was incomplete with the prescription medication being logged onto the MARS. A deficiency was cited. Based on observations, staff interviews, and records review two deficiencies and two technical violation were cited during the visit. An exit interview was conducted Per California Code of Regulations, (Title 22, Division & Chapter 6), are being cited on the attached LIC809D and a civil penalty will be assessed in the amount of $800. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC421BG and appeal rights was reviewed, discussed the provided to the facility representative Melona B. Whitelaw and Administrator, Arminda Lopez.the state’s words, verbatim · CDSS document, Mar 10, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Green Willow Home Care Facility unannounced to conduct the Annual Inspection. LPA knocked on the door and was greeted by Care Staff, Jocelyn Santiago and granted entry. LPA introduced self and stated purpose of the visit. Administrator, Rosemarie Sumadsad and Care Staff, Miguelito Veluz arrived later during the visit. LPA was accompanied by Jocelyn Santiago on a tour inside and outside, and observed the following: Facility: The Facility is licensed for six (6) non-ambulatory adults, 1 bedridden and a Hospice Waiver for 6 residents. LPA observed that the facility is operating in the capacity and conditions approved by Community Care Licensing (CCL). Physical Plant: LPA Coleman observed the facility's temperatures to be maintained comfortably. The facility is comprised of 2 Living Rooms, Dining Rooms, Resident/Staff Rooms, Bathrooms, Kitchen, Backyard and attached garage. Resident Room contained all required furnishings. Restrooms are maintained for staff and residents. Each bathrooms included operable appliances, adequate paper supplies, non-slip grip materials and handrails. Extra supplies of linens, towels, hygiene supplies were located in the bathroom and hallways. The facility was sufficiently lit by various lamps and night lights throughout. The facility is equipped with operable fire/smoke alarms, carbon monoxide detectors. Fire Extinguisher was located in the kitchen; fully changed and last inspected January 2024. The facility's Emergency Disaster Plan, Facility Sketch and Evacuation Plan was reviewed; as it was posted in a prominent place. Kitchen/Food Service: LPA observed the food supply; the amount of nonperishable and perishable food is sufficient for number of residents in care. LPA's visit was during lunch. LPA witnessed food prepared and stored properly. Sharp objects were secure and inaccessible to residents in care. Please see LIC809-C Garage - In the facility's attached garage, LPA observed the emergency food supply was well stocked. LPA also observed that the facility centrally stores medications securely in this area. Care & Supervision: Facility has sufficient care staff; who also reside on facility grounds. toxic items are inaccessible to residents in care and stored and locked in a filing cabinet in the office. Record Review of Resident/Staff Files: LPA reviewed records for all six (6) residents in care. Resident records are all complete with updated Physician's Reports, Admissions Agreements, Appraisals and Needs and Services Plans. LPA reviewed all two (2) staff files. LPA confirmed that staff records reflect current CPR/First Aid Certification, Criminal Record Clearances, Fingerprinting, Personnel Records and Health Screenings. The Administrator's Administrator Certificates were posted and observed in good standing. Signs/Posters: LPA observed the following signs posted in a prominent place: Facility Sketch Disaster Plan, Long Term Care Ombudsman, Resident Rights, Resident Council, Theft and Loss Policy, Staff Roster, Visiting Hours, Daily Schedule and facility license are posted in the hallway of the facility. Emergency Disaster Plan is current. Medication/Medical Related Services: LPA observed that the resident's medications are centrally stored and secure in file cabinets in the kitchen and garage. LPA reviewed all the resident's medications and compared it to the facility's Medication Administration Report (MARs) and Centrally Stored Medication Log. Based on observations, staff interviews and records reviews, no deficiencies were cited during visit. An exit interview was conducted. This report was reviewed, discussed then provided to Facility Representative.the state’s words, verbatim · CDSS document, Feb 15, 2024