Blossom Haven

Type of visit: Required - 1 Year

On 12/16/2025 Licensing Program Analysts (LPAs) B. Miranda and J. Duarte arrived at the facility unannounced to conduct an annual inspection. LPAs were greeted by staff Ahli Vang and allowed entrance into the facility. Administrator Ly was contacted and arrived shortly after. Facility is licensed for a capacity of 6 and has a current census of 4. Upon arrival LPA observed residents siting in the living room waiting to go to day program. Fire extinguisher was last serviced 12/18/2025 and still holds charge. Smoke detectors & carbon monoxide detectors were tested and are in working order. LPAs observed knives and medication to be locked and inaccessible to residents in care. LPAs observed resident rooms which are properly furnished with adequate lighting. Exits are accessible and free from obstruction. During the tour LPA observed the dishware in the kitchen needing to be cleaned due to buildup at the bottom of the dishware. LPA observed tools accessible to residents in the garage and outside in the cabinets/drawers. LPA observed an outside cooking area needing to be cleaned to prevent pests. Administrator verified there is no current infection control plan in place or completed. LPAs tested water in different areas which did not meet the requirement of 105 degrees. LPAs reviewed resident files which are current and up to date. A sample of staff files were reviewed and are current and up to date. Exit interview was conducted. A copy of this report LIC809, LIC809D, and appeal rights were provided to Administrator Ly Sy Jalao.the state’s words, verbatim · CDSS document, Dec 16, 2025

Type of visit: Required - 1 Year

On December 2, 2024 Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced visit and met with Administrator (AD) Ly Sy Jalao. The purpose of the visit was to conduct the Required Annual inspection. During this visit, LPA and AD toured the facility. The facility has a current census of 3. Resident rooms contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring at 102.5 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPA observed required emergency food supply and paper products. Medications are centrally stored and locked in pantry. Doors and passageways are unobstructed throughout the facility including outdoor patio. Facility has two First Aid kits, they are located in the kitchen pantry and in the emergency supplies. Both contained required items. Sufficient supply of perishable and non-perishable food observed. There is a Fire Extinguisher located on kitchen counter which was last serviced through February 2025. Smoke and Carbon Monoxide detectors are tested and found to be operational. LPA conducted resident and staff file reviews and required documentation was present in both. There are no deficiencies or technical violations issued at today's visit. An exit interview was conducted. A copy of this report was discussed and left with Administrator, whose signature on this form confirms receipt of this document. LPA is requesting the following documents be submitted to the Fresno CCL office by 12/30, 2024: Copy of property grant deed, 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), Surety Bond.the state’s words, verbatim · CDSS document, Dec 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA was granted entry to the facility by Staff (S1). S1 called Administrator Sy Ly (AD) who arrived shortly thereafter and LPA explained the purpose of the visit. During this visit, LPA and AD toured the facility. The facility has a current census of 3. Resident rooms contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring at 114.5 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPA observed required emergency food supply and paper products. Medications are centrally stored and locked in pantry. Doors and passageways are unobstructed throughout the facility including outdoors. Facility has two First Aid kits, they are located in the kitchen pantry and were found to contain required items. Sufficient supply of perishable and non-perishable food observed. Fire Extinguisher is located on kitchen counter and was serviced on 12/5/2023. Smoke and Carbon Monoxide detectors are tested and found to be operational. LPA conducted resident and staff file reviews and interviews. Technical violations are being cited in accordance with California Code of Regulations. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with Administrator, whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 12/29/23:Copy of property grant deed, 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), Surety Bond.the state’s words, verbatim · CDSS document, Dec 19, 2023

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.