Greenleaf Care Home

Type of visit: Required - 1 Year

On 07/28/2026 at 1:10PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived to conduct an unannounced 1-Year Required inspection. LPA met with Liezyl Ajos, Administrator, and explained the purpose of the visit. Administrator holds certificate #7019104740 which expires on 12/01/2027. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms, one (1) occupied by staff and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 76 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 105.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Continue on LIC809C.... Continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/11/2025. Emergency Disaster Plan was last posted on 07/28/2026. First aid kit was observed to be complete. Fire drill was last conducted on 11/07/2025. Facility fire drill is scheduled for 07/29/2026. LPA reviewed four (4) staff records all staff have FirstAid/CPR. LPA reviewed all four (4) resident records and they all were current and complete. LPA also reviewed medication and MAR during visit. LPA requested the following documents to be submitted to CCLD by 08/04/2026. Resident Roster LIC 308 Designation of Administrative Responsibility Liability insurance. LIC 500 Personnel Report LIC 610E Emergency Disaster Plan. Exit interview conducted. A copy of his report provided.the state’s words, verbatim · CDSS document, Jul 28, 2026

Type of visit: Required - 1 Year

On 07/31/2025 at 10:33AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived to conduct an unannounced 1-Year Required inspection. LPA was greeted by Teresita Inocentes, Caregiver. LPA met with Caregiver Katherine Buenaflor, Caregiver, who spoke with Administrator Liezyl Ajos via telephone, and explained the purpose of the visit. The Administrator arrived at 11:01AM. Administrator currently holds a certificate (7019104740) that expires on 12/01/2025. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 113.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Continue on LIC809C Continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/11/2025. Emergency Disaster Plan was last posted on 06/30/2025. First aid kit was observed to be complete. Fire drill was last conducted on 11/11/2024. LPA reviewed three (3) staff records all three staff has FirstAid/CPR, S2 is missing health screening and S3 is not associated to facility. LPA reviewed all five (5) resident records they all were complete. LPA observed the following deficiencies during visit: At 11:24AM, LPA observed medication in an unlocked kitchen drawer At 11:29AM, LPA observed empty boxes, bed mattress, furniture, Hoyer lifts, luggage and wheel chairs in garage. At 11:30AM, LPA observed an exit door in the garage off the hinges, screw driver holding latch in place At 11:36AM, LPA observed a wooden shelf, walker, Hoyer lift and mattress and bed rails on top of a table in backyard At 12:26PM LPA observed during staff record review S2 missing health screening and S3 is not associated to the facility Continue on LIC809C Continued from LIC809C LPA requested the following documents to be submitted to CCLD by 08/08/2025. Resident Roster LIC 308 Designation of Administrative Responsibility Liability insurance. LIC 500 Personnel Report LIC 610E Emergency Disaster Plan. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421BG, and this report providedthe state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: Facility staff did not assist resident in obtaining transportation services

On 06/11/2025 at 9:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with Katherine Buenaflor, Caregiver and explained to her the reason for the visit. Katherine contacted Administrator, Liezyl Ajos via telephone. Administrator, Liezyl Ajos arrived at 10:13AM, LPA explained purpose of visit. During the course of investigation, LPA conducted interviews with staff (S1) and (S2), resident’s physician’s report, admissions agreement, transportation and appointment logs were obtained and reviewed. Continue on LIC9099C Substantiated Continued from LIC9099 Facility staff did not assist resident in obtaining transportation services During investigation, LPA interviewed staff and reviewed documents. During interview it was revealed S1 and S2 admitted to scheduling the transportation pickup for wrong date and time resulting in R1 missing doctor appointment. R1 had a scheduled doctor appointment for 03/27/2025, scheduled transportation pickup for the 03/26/2025. During documentation review it was revealed that the scheduled pickup date for 03/28/2025 was also missed due to transportation not arriving at the facility to take R1 to rescheduled doctor appointment, R1 missed two scheduled doctor appointments. Based on the Department’s investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report providedthe state’s words, verbatim · CDSS document, Jun 11, 2025 · control 15-AS-20250328151521

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80075(a) · Plan of correction due date: Jun 20, 2025

80075 Health Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services... This requirement was not met as evidence by: Based on records review and interviews, licensee failed to ensure that resident had transportation to attend scheduled doctor appointment, which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 11, 2025

Plan of correction: Licensee agreed to implement a plan to prevent this from happening in the future and send CCL an email of plan by POC date.

Allegation investigated: Financial Abuse Staff threatened to fight resident

On 02/11/2025 at 11:00AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver complaint findings for the allegations above. Upon arrival, LPA met with Katherine Buenaflor, Caregiver and explained to her the reason for the visit. Katherine contacted Administrator, Liezyl Ajos via telephone. Administrator, Liezyl Ajos arrived at 11:18AM, LPA explained purpose of visit. During the course of the investigation, the Department conducted interviews with staff, R1’s daughter and complainant. Resident’s physician's report, R1's after visit summary dated 12/02/2024, admission agreement and appraisal need, and services plan records were obtained and reviewed. LPA couldn’t interview R1 due to R1 being diagnosed with dementia. Continue on LIC9099C Unsubstantiated Continued from LIC9099 Allegation: Financial Abuse: Based on interviews with staff and R1's daughter. R1’s daughter stated the money R1 receives monthly from Supplemental Security Income (SSI), is sent directly to the facility and that R1 has no contact with money at all. Staff stated they have not seen R1 with money since she’s been at the facility and that staff spends their own money on R1 when they would take R1 out into the community. Allegation: Staff threatened to fight resident. Based on file review and interview, R1’s physician report dated 05/29/2024 revealed that R1 has dementia, confused and disoriented. Based on interview, R1’s daughter stated that R1 has suffered severe brain damage for over forty (40) years and as a result R1 has extremely aggressive behavior and can be difficult to work with at times. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided to Administrator, Liezyl Ajos.the state’s words, verbatim · CDSS document, Feb 11, 2025 · control 15-AS-20241211150341

Type of visit: Required - 1 Year

On 07/19/2024 at 11:13AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived to conduct an unannounced 1-Year Required inspection. LPA was greeted by Maricar Michellin. LPA met with Caregiver Gina Manlo who spoke with Administrator, Liezyl Ajos via telephone, and explained the purpose of the visit. The Administrator arrived at 11:43AM. Administrator currently holds a certificate (#7019104740) that expires on 12/01/2025. Facility has census of 3. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA observed a Maricar Michellin preparing food and Two (2) residents eating at the kitchen table upon entry. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 85 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 116.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/11/2023. Emergency Disaster Plan was last posted on 12/25/2023. First aid kit was observed to be complete. Fire drill was last conducted on 12/11/2023. Continued LIC809C. Continued from LIC809. Three (3) staff records were reviewed. During record review one (1) staff did not have Health Screening LPA reviewed all Three (3) resident records, During record review all three(3) residents didn't have Appraisal Needs and Service Plans LPA requested updated copies of the following documents to be submitted to CCLD by 07/26/2024. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · Liability Insurance · Current Administrator’s Certificate LPA observed the following deficiencies: · At 11:20AM, LPA observed house guest preparing food in the kitchen. (S1) advised LPA of house guest not being associated or fingerprinted and that she's only visiting from another country · At 12:05PM, LPA observed unlocked closet with laundry detergent inside · At 12:11PM, LPA observed unlocked drawer with scissors Continue on LIC809C continued from LIC809C · At 12:12PM LPA observed Refrigerator door handle was broken · At 1:28PM LPA observed during record review that all three (3) residents were missing Appraisal Needs and Service Plans · At 1:56PM LPA observed during record review that (S3) did not have health screening · At 2:05PM LPA observed roaches crawling on counter top near fruit basket *The total amount of civil penalties assessed on today's date is $100.00 for volunteer not being associated or finger print cleared. * Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421BG, and the report provided.the state’s words, verbatim · CDSS document, Jul 19, 2024

Type of visit: Case Management - Health Checks

On 05/20/2024 at 3:55PM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted a Health & Safety inspection as a result of client relocating. LPA met with caregiver, RejyJonnah Requiez and explained purpose of visit. Caregiver RejyJonnah contacted Administrator via telephone. Administrator, Liezyl Ajos arrived at 4:15PM, LPA explained the purpose of the visit. Upon arrival, LPA observed total of two (2)staff(S1, and S2)and four (4) clients(C1, C2, C3 and C4) home during visit. LPA toured facility including but not limited to the bedrooms, bathrooms, common area and kitchen. Hot water temperature was measured at 108.1 degrees Fahrenheit in the common bathroom. Facility is maintained at a comfortable temperature of 80 degrees Fahrenheit for the clients in care. 7-days of non-perishable and 2-days of perishable food supplies were observed. Clients in care appear to be safe and there are no imminent health/safety concerns. Facility is noted to be clean and in good repair. No deficiencies cited during visit. Exit interview conducted and a copy of this report providedthe state’s words, verbatim · CDSS document, May 20, 2024

Type of visit: Required - 1 Year

On 12/13/2023 at 9:10 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Liezyl Ajos and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Liezyl including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured within range of 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. First aid kit was observed to be complete. Fire extinguisher was last serviced on 10/11/2023. Report continues on 809 C At 9:25 AM, LPA reviewed 4 of 4 residents records. At 10:00 AM, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 10:50 AM, LPA reviewed a sample of 4 of 4 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL via fax by 12/27/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 page version) Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 13, 2023