Blossom Care for Elderly

Type of visit: Annual/Random

On 8/29/2026 at approximately 12:00 PM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by a staff member (S3) and stated the reason for their visit. The Administrator, Romuel Neria was called via telephone by S3 where it was disclosed, they would be unavailable to attend today’s visit. The Administrator sent the facility’s designee, Regina Jacinto to assist with today’s visit. Upon arrival, LPA was greeted by two staff members, S2 and S3. LPA observed S3 to be assisting residents with food preparation along with transporting R4 to the dining room and serving them lunch. LPA’s interview with S3 revealed they were at the facility preparing lunch for the residents which contradicted LPA’s interview with the Administrator (S1) who stated S3 was just a visitor. The Administrator eventually revealed after being questioned multiple times by LPA, that S3 was currently being trained and in the process of obtaining criminal record clearance. LPA’s record review of The Department of Social Services Guardian database confirmed S3 not to be associated with the facility nor have criminal record clearance. Let it be noted the facility has been cited for this during their last annual inspection on 5/13/2025. Upon the arrival of the facility’s designee, S3 was excused from work and sent home by the Administrator. LPA conducted a physical plant tour at approximately 2:00 PM and the following was noted: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms. The facility is currently occupying five (5) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver approved for six (6). (continue to LIC 809-C) Medications: The medications were observed to be kept in a locked cabinet located near the kitchen. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared not to be complete and updated. Staff records: LPA conducted a complete file review of three (3) staff records. Staff records appeared to be complete and updated. Citations issued, please refer to LIC 809-D. Additionally, a civil penalty for $100 per day for a maximum of 5 days in the amount of $500 for criminal record clearance violation is being assessed on the attached LIC 421BG. No other immediate health and safety issues observed during the day of the visit. LPA discussed the findings of today’s visit with the Administrator. LPA along with the Administrator created the Plan of Corrections (POC) regarding the citations. Exit interview was conducted, appeal rights given and a copy of this report was provided to the facility’s Designee. Common areas: The living rooms and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 76°F. LPA observed multiple fire extinguishers to be located throughout the facility and dated 11/19/2025. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights to be located alongside the entrance. A working telephone was observed. LPA observed the fireplace to be covered and inaccessible to residents. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in cabinets located within the hallway’s passageway. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility. Laundry Room: The laundry room was observed to be kept locked. LPA observed cleaning solutions and toxins stored appropriately within the laundry room and inaccessible to residents. The laundry appliances were observed to be in proper condition. Garage: The garage can be accessed from inside of the facility and was observed to be located next to the laundry room. The garage was observed to be kept locked and used for storage purposes. (continue to LIC 809-C)the state’s words, verbatim · CDSS document, Aug 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 30, 2026

87355 Criminal Record Clearance. (e) All individuals...shall prior to working, residing or volunteering in a licensed facility:...(2) Obtain a California clearance or a criminal record exemption as required by the Department... This requirement was not met evidenced by: Based on interviews, record review and observations S3 did not have criminal record clearance and was observed helping residents in the facility which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2026

Plan of correction: The Administrator/Licensee will email LPA Segovia the criminal record clearance for the working staff member (S3) and that person cannot return to the facility until clearance has been approved. POC due date: 8/30/2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Sep 11, 2026

87463 Reappraisals. (a) The pre-admission appraisal..., shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first,...shall be referred to as the reappraisal. This requirement was not met evidenced by: Based on interviews, record review and observations three of the five residents were missing their re-appraisals which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2026

Plan of correction: The Administrator/Licensee will conduct the reappraisals for all 3 residents and email LPA Segovia the required documentation by POC due date. Additionally, the Licensee will review the regulation and email LPA Segovia a statement of understanding. POC dude date: 9/11/2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(h) · Plan of correction due date: Sep 11, 2026

87463 Reappraisals. (h)The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months... This requirement was not met evidenced by: Based on interviews, record review and observations four of the five residents were missing their annual medical which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 29, 2026

Plan of correction: The Administrator/Licensee will review the regulation and email LPA Segovia a statement of understanding along with the required documentation of all residents missing their annual medical by POC due date: 9/11/2026

Type of visit: Required - 1 Year

On 5/13/2025 at approximately 10:15 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. Upon LPA’s arrival, LPA observed six (6) residents under the care and supervision of a staff member who has no criminal record clearance nor associated to the facility. The Administrator, Romuel Neria arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted: The facility is a single-story building with four (4) bedrooms and two (2) bathrooms currently occupying six (6) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Sign in sheet, hand sanitizer, gloves and masks are available upon entrance. Common areas: The living rooms and dining rooms were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 72°F. LPA observed a fire extinguisher to be located in the kitchen and dated 05/13/2025. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights alongside the entrance leading towards the kitchen. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. (continued on LIC 809-C) The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in cabinets located in the hallway’s passageway. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 120.0 °F. Laundry Room: The laundry room was observed to be located in the hallway leading towards the bedrooms. LPA observed the laundry room to be kept locked. LPA observed cleaning solutions and toxins stored within the laundry room and inaccessible to residents. The laundry appliances were observed to be working and in proper condition. Garage: The garage can be accessed from inside of the facility and is located next to the laundry room. LPA observed the garage to be used for storage purposes. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility. Medications: The medications were observed stored in a locked cabinets located aside the kitchen. LPA observed staff and resident files to be kept locked in a cabinet located in the staff/reception desk area. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, and First Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records and observed two (2) working staff file missing required documentation. There were no other immediate health and safety hazard observed during the day of inspection. Citations issued, please refer to LIC 809-D. A civil penalty for $100 per day for a maximum of 5 days in the amount of $500 for criminal record clearance violation is being assessed on the attached LIC 421BG. Exit interview conducted, Appeals Rights given, and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, May 13, 2025

Allegation investigated: Staff did not address resident's medical condition- Staff did not ensure resident's bedding was cleaned- Staff did not keep facility free of insects-

On Monday, 9/23/24, at 11:00am, Licensing Program Analyst (LPA), Raymond Comer, conducted an initial complaint inspection to investigate the above mentioned allegation(s). LPA Met with caregiver, Joseph Neria, who cooperated and assisted during the visit. The Administrator, Romuel Neria, was reached by cell phone, and the reason for the visit was disclosed. Later, around 12:30pm, the Administrator did arrive to the facility, met with the visiting LPA, and cooperated with LPA regarding the investigation. Allegation: Staff did not address resident's medical condition- Reporting Party (RP) alleges that Resident#1 (R1) developed skin blisters, and that Staff failed to seek medical attention in a timely manner. LPA conducted interviews, and reviewed documents. (i.e., medical records, medical assessments, and nurse’s notes) [LIC 9099C]-continued Unsubstantiated Information gathered by LPA reveals that facility Staff were indeed diligent in observing R1’s skin condition and did provide R1 access to medical attention in a timely manner. According to resident files, and interviews with Staff, R1 was recently admitted to this facility. Staff, along with attending family members, transported R1 to meet their Primary Care Physician. (PCP) A review of the doctor's notes indicate that R1's rash/blistering is a result of an autoimmune skin condition. The PCP prescribed medication to treat R1's skin condition. LPA interviews with Staff revealed that the prescribed medications are improving t R1's skin condition. Based on LPA observation, interviews, and records review, this allegation is UNSUBSTANTIATED at this time. Allegation: Staff did not ensure resident's bedding was cleaned- Reporting Party (RP) alleges that facility is unsanitary, as Residents' sheets are dirty and are soiled. LPA conducted an facility observation, and interviewed Staff and Residents. LPA's inspection of facility, with particular focus of all resident rooms and bedding, reveals that resident linens, towels, and bedding, are cleaned and well maintained. Interviews with the Administrator, Staff, and Residents indicate there is no issues regarding the cleanliness of resident bedding, nor overall concerns regarding the cleanliness of the facility. Based on LPA observation, and interviews, this allegation is UNSUBSTANTIATED at this time. Allegation: Staff do not keep facility free of insects- Reporting Party (RP) alleges that resident's sheets are dirty with ants, and/or other types of pests. LPA conducted an facility observation, and interviewed Staff and Residents. LPA's inspection of facility, with particular focus of all resident rooms and bedding, reveals that facility is free of pests. Interviews with the Administrator, Staff, and Residents indicate there is no issues regarding the the presents of pests/vermin at the facility Based on LPA observation, and interviews, this allegation is UNSUBSTANTIATED at this time. An exit interview was conducted and report was provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 23, 2024 · control 31-AS-20240917112355

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Evelin Rios met with Romuel Neria (Applicant/Administrator) for a follow-up Pre-licensing inspection. LPA needed to verify that the facility has made the corrections needed to meet licensing standards. LPA conducted a physical plant inspection to verify grab bar for the toilet in the private bathroom was added correctly and to verify 4 resident bedrooms are fully furnished and furniture is arranged appropriately. Prior to visit Romuel submitted pictures to LPA Rios on 06/16/2024 and 06/17/2024 of corrections made. Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete. LPA Rios will notify the Centralized Applications Bureau (CAB) Analyst of the completed Pre-Licensing inspection. An exit interview was conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Jun 25, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Evelin Rios met with Romuel Neria (Applicant/Administrator) for a Pre-licensing inspection. On 02/06/2024 the Department substantiated the allegation of Unlicensed Care. The Operator Romuel submitted an application to the Department to become licensed on 02/22/2024. There is one resident residing in the home. The facility has 4 bedrooms and 2 bathrooms. Fire clearance is for 5 non ambulatory residents and one room is designated for one bedridden resident for a total capacity of 6. Rooms available are for private use of which two may be shared. There is a dementia plan of operation. There will be a wake night staff. Entrance interview conducted. LPA conducted a physical plant tour of the facility inside and out and the following was observed: Common Areas: Upon entry LPA observed appropriate facility postings. LPA observed the facility to be clean and furniture to be in good condition. LPA did not observe any obstructions throughout the facility. There is a fireplace with a screen. The facility phone was operational. There are two dining and sitting areas that accommodate the capacity of the facility. LPA toured the outside backyard grounds. LPA observed appropriate outdoor furniture with an umbrella for shade. There are no bodies of water. Bedrooms: LPA observed all bedrooms to be clean with appropriate lighting, closet space, chairs, night stands, and window coverings with screens. LPA observed one bed in one of the shared bedrooms with appropriate bed, mattress, bedding, and dresser. LPA reviewed a purchase receipt for five beds, mattress and dressers with delivery date scheduled between 06/14/2024 and 06/24/2024. Extra linens, toiletries and first aid kit were observed in a linen closet by the bedrooms. LIC809 Continued on next page. The smoke alarm and carbon monoxide detectors were tested by applicant at 10:36 a.m. and were observed operational. Three fire extinguishers appear to be fully charged with purchase date 02/08/2024. The facility maintains a comfortable temperature at 76 degrees F which meets regulation. Bathrooms were observed clean and supplied with toilet paper, hand soap, paper towels and hot water taken at 11:33 a.m. measured at 115.9 degrees F. Showers in both bathrooms have appropriate non-skid mats and grab bars. One out of the two toilets have a commode with grab bars. Kitchen: LPA toured the kitchen area LPA observed a sufficient amount of food and water supply. LPA observed the sharp knives in a locked kitchen drawer inaccessible. LPA observed cleaning chemicals locked in cabinet under the sink. The stove oven and the refrigerator were clean and in good operation. Laundry Room and Garage: The laundry room and garage are accessible to residents. LPA observed a washer a dryer that appeared operational. LPA observed laundry detergents locked in a cabinet in the garage. LPA observed extra supply of water in the garage. LPA observed tools looked in a supply closet in the garage. Medications and medication records are kept centrally stored and locked in a cabinet by one of the dining areas. Resident and staff records are kept locked in a cabinet by one of the dining areas. Component III Orientation with the Administrator/Applicant was also conducted during the visit. The licensee will need to complete the following: 1. Grab bar for the toilet in the private bathroom. 2. 4 bedrooms fully furnished and furniture arranged appropriately. Submit by June 25, 2024. Pre-licensing is incomplete with deficiencies to be resolved by 06/25/2024. A follow up Pre-licensure LIC809 will be generated upon resolution. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 11, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Romuel Neria, Licensee/Administrator Interview Method: Virtual interview On 4/30/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 30, 2024