Green Feathers Assisted Living

Type of visit: Required - 1 Year

On 09/24/2026 at 9:30AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Vilma Noda, Caregiver, and explained the purpose of the visit. Vilma contacted the administrator via telephone. Pramod Balanandan, House Manager arrived at 10:30AM. Facility has census of 6. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Caregiver, Vilma Noda including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) 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 71 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 135.1 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 08/18/2026 Emergency Disaster Plan was last posted on 07/10/2026. First aid kit was observed to be complete. Fire drill was last conducted on 07/10/2026. Continued LIC809C. Continued from LIC809. LPA reviewed five (5) staff records, all five (5) staff have criminal record clearance and hold a current first aid certificate. LPA also reviewed all six (6) resident records during visit. LPA requested updated copies of the following documents to be submitted to CCLD by 10/01/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Updated facility sketch LPA observed the following deficiencies: At 10:27AM, LPA observed facility has mattress, bed box spring, wheelchairs, walkers, oxygen tank, hospital head/foot boards and bed frames inside garage At 10:39AM, LPA observed facility’s hot water measured 135.1 At 11:33AM, LPA observed facility does not have Dr. orders on record for R1’s HOYER lift, wheelchair and half bed rails At 12:08PM, LPA observed S5 does not have TB test on record Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Pramod Balanandan. Exit interview conducted and appeal rights copy of this report providedthe state’s words, verbatim · CDSS document, Sep 24, 2026

Type of visit: Required - 1 Year

On 08/27/2025 at 1:50PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Candido Nerona, Caregiver, and explained the purpose of the visit. Candido contacted the administrator via telephone. Pramod Balanandan, House Manager arrived at 2:40PM. Facility has census of 5. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Caregiver, Candido Nerona including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) 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 75 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 120.4 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. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/15/2025. Emergency Disaster Plan was last posted on 01/05/2025. First aid kit was observed to be complete. Fire drill was last conducted on 08/07/2025. Continued LIC809C. Continued from LIC809. LPA reviewed four (4) staff records, all four(4) staff have criminal record clearance and holds a current first aid certificate. LPA also reviewed all five (5) resident records. they were complete. LPA requested updated copies of the following documents to be submitted to CCLD by 09/03/2025 LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Updated facility sketch No deficiencies were cited during today’s visit. Exit interview conducted and a copy of this report provided to Pramod Balanandan.the state’s words, verbatim · CDSS document, Aug 27, 2025

Type of visit: POC

On 09/24/2024, at 10:40AM, Licensing Program Analyst (LPA) T.Syess-Gibson arrived unannounced to conduct a proof of correction (POC) visit. LPA met with Emilia Palpallatoc, Caregiver, and explained the purpose of the visit. Emilia, contacted Administrator via telephone, explained purpose of visit. Administrator gave Emilia Palpallatoc authorization to sign reports. LPA conducted an annual inspection on 09/11/2024 and cited for the following deficiencies that has not been corrected. 87608(5)(A)- LPA observed facility having two (2) residents with bed rails without doctor orders. 87307(d)(6)- LPA observed facility having five(5) gallons of paint and primer, window screens and patio table umbrella in the backyard. Each uncorrected deficiency is $100.00 x 6 = $1200.00. Civil Penalties in the total amount of $1200.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing civil penalties until deficiencies are corrected. Continued on LIC809C. Continue fro LIC809 LPA conducted an annual inspection on 09/11/2024 and cited for the following deficiency: 87705(5)(A)- LPA observed annual medical assessment and appraisal needs and service for resident with dementia were not in resident's files. LPA wasn't able to verify during POC visit if the citation was corrected. Emilia Palpallatoc , Caregiver informed LPA of not having access to the resident's files and that the Administrator has the key to the file cabinet. Exit interview conducted. A copy of this report, LIC809D, LIC421FC, and appeal rights provided. Continue on LIC809Dthe state’s words, verbatim · CDSS document, Sep 24, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Sep 25, 2024

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Administrator agreed to have resident's files readily available to facility staff and licensing agency staff. Administrator will send a self certifying email to CCLD by POC date.

Type of visit: Required - 1 Year

On 09/11/2024 at 10:27AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver Vilma Noda, spoke with Administrator, Pramod Balanandan via telephone, and explained the purpose of the visit. The Administrator arrived at 11:15AM and currently holds a certificate (#6050378740) that expires on 01/16/2025. Facility has census of 5. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Caregiver, Candido Nerona including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) 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 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 at 109.9 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 08/30/2024. Emergency Disaster Plan was last posted on 06/02/2024. First aid kit was observed to be complete. Fire drill was last conducted on 08/17/2024. Continued LIC809C. Continued from LIC809. LPA reviewed five (5) staff records and five (5) resident records. LPA also reviewed medications. LPA requested updated copies of the following documents to be submitted to CCLD by 09/18/2024 · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · Liability Insurance LPA observed the following deficiencies: ·At 10:40AM, LPA observed during tour, two (2) of the five (5) residents has bed rails without doctor's orders. · At 10:50AM, LPA observed during tour of backyard, a five (5) gallons of paint and primer, broken window screens and an umbrella for a patio table in the backyard leaning against the fence. · At 12:25PM, LPA observed during record review R1 doesn't have a current medical assessment (LIC602) The last medical assessment is dated 03/08/2023. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 11, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.