Green Gables Care Home V

Type of visit: Required - 1 Year

On 3/26/26 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Karenmay Baniaga, LPA was granted entry. 6 residents were present during inspection. Administrator (A1) Mario Ramos arrived shortly after LPA’s arrival. LPA toured facility with S1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were checked and observed locked in kitchen cabinet. Clients’ MARS was reviewed. Fire extinguisher reviewed with a purchase date of: 10/1/25. Fire drill completed on 2/10/26. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Resident’s bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 109.9 to 114.9 degrees in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at -17 degrees F and refrigerator temperature maintained at 31 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All clients’ files and staff’s files reviewed to have all the required documents. No deficiencies issued during today's inspection. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 4/9/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A) A copy of this report was provided to S1, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Mar 26, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 3/26/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Karenmay Baniaga, LPA was granted entry. 6 residents were present during inspection. Administrator (A1) Mario Ramos arrived shortly after LPA’s arrival. LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were checked and observed locked in kitchen cabinet. Clients’ MARS was reviewed. Fire extinguisher reviewed with a service date of: 10/14/24. No fire drill completed or logged in facility. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Resident’s bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 113.9 to 117.3 degrees in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at -13 degrees F and refrigerator temperature maintained at 37 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All clients’ files and staff’s files reviewed to have all the required documents. The following deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 4/9/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A) A copy of this report and appeal rights was provided to A1, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Required - 1 Year

On 05/24/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with staff Teresita Delatorre, Mario “Danny” Ramos, Assistant arrived shortly. All seven residents were present during the inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. All residents’ and staffs’ files reviewed. Fire extinguisher observed with purchased date 10/12/23. Medications were checked and observed kept locked in kitchen cabinet. Resident’s MARS was reviewed. Small live roaches were observed on the kitchen counter and on the toilet in bathroom 1. Assistant stated pest control have been schedule to come out on 05/24/24 at 2:00PM. Records of the pest control service will be submitted to LPA. An adequate supply of perishable and non-perishable food was observed. All residents’ bedrooms were toured. LPA observed single occupant in bedroom 1, single occupant in bedroom 2, single occupant in bedroom 3, single occupant in bedroom 4, and 3 resident’s bed in shared bedroom 5. LPA observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars. Hot water temperature was tested range 115.3 and 116.2 degrees F. in bathroom and range 114 and 113.8 degrees F in shared bedroom bathroom. Toilet was observed functioning and operational. Cleaning chemicals observed locked in the laundry room. Outside of facility toured and observed free of debris with adequate outdoor seatings. Side gate was observed self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. A deficiency and an immediate Civil Penalty of $500 was assessed. See Lic 421IM is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 05/30/24. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, current Administrator Certificate, and current liability insurance. A copy of this report and appeal rights was provided to Assistant, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, May 24, 2024

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.