Blossom Garden Senior Home

Type of visit: Required - 1 Year

On this day, December 10, 2025, at 12:10 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Fekerte Hyesus, administrator (ADM), and informed the reason for visit. LPA toured the facility inside out with ADM. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has smoke and carbon monoxide detectors that were tested, and observed in operating condition during visit. Facility conducts disaster drills quarterly, and records showed last conducted September 18, 2025. Fire extinguishers were observed fully charge with tags showed serviced May 2, 2025. Hot water in the common bathroom was tested. LPA reviewed 4 staff and 5 residents files. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. LPA received copy of $3M liability insurance certificate on this day. ....continued on 809C Administrator to submit updated copies of the following by December 24, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) The following deficiencies were observed and cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalty. -at 12:16 pm, lighter and peeler in kitchen cabinets without lock. -at 12:25 pm, closet doors derailed and bio hazard container in one of the residents' rooms. -at 12:29 pm, broken drawer knobs in residents' room. -at 1:32 pm, hot water was at 137 degrees Fahrenheit. -at 1:33 pm, lavatory sink not properly draining. -at 2:00 pm, residents' (R1 and R2) half bed rails don't have doctor's orders on file. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 10, 2025

Type of visit: Required - 1 Year

On 12/10/2024 at 10:25 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator and Licensee, Fekerte Hyesus and explained the purpose of the visit. At 11:05 AM, LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. The temperature inside the facility is maintained at 68 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 109.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable 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. Fire extinguisher was last serviced on 03/22/2024. Emergency Disaster Plan was posted visibly on the wall.First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/16/2024. At 12:25 PM, LPA reviewed 5 residents records and 5 staff records; all were complete. At 1:10 PM, LPA also reviewed a sample of resident’s medications. The following documents were requested and observed during the inspection: LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Copy of the Liability Insurance, and Current Administrator’s Certificate. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 10, 2024

Allegation investigated: Licensee is not cashing check payments for resident's (R1) rent and threatening eviction for non-payment.

At 11:50 am on this day, November 5, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Fekerte Hyesus, licensee-administrator (ADM), and informed the reason for visit. During the course of investigation, LPA interviewed R1's family member (FM) and ADM. LPA reviewed and obtained copies of R1's records and LIC500 Personnel Report. LPA also reviewed employee roster. LPA interviewed FM who stated he made an arrangement with the bank for the bank to send payments for monthy rents to ADM. The payment for September 2024 and October 2024 rent were sent by the bank with a returned receipt showing received and signed by A.A. FM stated the licensee told him that the payment was not received and threatened to evict R1. FM stated he cancelled the check and went to the facility in person on Saturday, 10/26/24, and paid the rent for the said months with a cashier's check. ......continued on 9099C Unsubstantiated LPA interviewed ADM who stated she never received the payments for the September 2024 and October 2024 and there's no staff with initial A.A. ADM stated R1's rent payments were always late 2, 3 days but she understand, because FM lives outside California; however, when she did not receive the payments for September 2024 and October 2024, she called FM but she never mentioned about eviction. ADM confirmed that FM came on October 26, 2024 and gave a cashier's check for September 2024 and October 2024 rent payment. Based on interviews and review of staff roster and LIC500 Personnel Report showing no staff with A.A. initial, the allegation is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 15-AS-20241028082254

Type of visit: Required - 1 Year

On this day, December 7, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Fekerte Hyesus, administrator, and informed the reason for visit. LPA also met with other staff, Avelina Sagnep. Administrator submitted the facility's Infection Control Plan which LPA received on November 11, 2022. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Facility conducts disaster drills quarterly, and records showed last conducted September 15, 2023. Fire extinguishers checked, observed fully charge with tags showed serviced May 25, 2023. LPA reviewed 4 staff and 5 residents files, and interviewed 2 staff and 2 residents. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. LPA received the following updated/current documents: 1. LIC500 Personnel Report 2. LIC610E Emergency Disaster Plan (9 pages) .....continued on 809C Administrator to submit copies the following by December 21, 2023: 1. $3M Liability Insurance certificate 2. LIC308 Designation of Facility Responsibility The following deficiencies were observed and cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. -at 12:30 pm, knives in kitchen cabinets without lock. -at 12:33 pm, bleach, cleaning agents, and Comet cleanser in the Alarm Panel room without lock -at 2:00 pm, administrator's First Aid certificate expired 11/24/23. -at 2:10 pm and 2:25 pm, S2 and S3 have no LIC503 Health Screening on file. -at 2:35 pm, S4 who got hired 7/2023 has only 21 hours training on file. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 7, 2023