Blessed Homecare

Type of visit: Required - 1 Year

On 11/20/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1 year annual inspection utilizing the care tool. LPA met with Administrator Leriza Arambulo and explained the purpose of the visit. LPA and Administrator conducted a tour of the facility. Areas toured include but not limited to residents bedrooms, bathrooms, kitchen, and common areas LPA observed facility to have required licensing posters. LPA observed medications, sharps, toxins to be locked and inaccessible to residents in care. LPA observed two (2) days of perishable and seven (7) days on nonperishable foods. LPA observed facility to be clean, sanitary and free of hazardous obstruction. Fire extinguisher was last serviced on 10/31/2025. LPA conducted a file review of six (6) resident files and medications. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. LPA reviewed two (2) staff files. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of the report and LIC809G was left at the facility.the state’s words, verbatim · CDSS document, Nov 20, 2025

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Cassandra Mikkelson arrived at the facility unannounced to conduct a case management visit. LPAs met with Administrator Leriza Arambulo and explained the purpose of the visit. The purpose of this inspection is to follow-up on issues that were discussed in the Non- compliance meeting that took place on 11/18/2024. The facility is currently licensed for (6) non-ambulatory, hospice waiver of six (6). During today's visit, there are six (6) residents and two (2) resident receiving hospice services. LPA compared medications to those being given for six (6) resident and found discrepancies. LPAs observed facility writing on prescription labels for multiple residents. Additionally, facility is pre-pouring five (5) days in advanced. As a result of today's inspection, deficiencies cited. Please see LIC809D Exit interview conducted and a copy of the report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Aug 26, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(4) · Plan of correction due date: Sep 9, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Based on observation facility was writing on prescription labels. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 26, 2025

Plan of correction: Licensee is to write a statement of understanding of this regulation and agrees that going forward willl not write on new prescription labels.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Sep 9, 2025

87465 Incidental Medical and Dental Care(h)The following requirements shall apply to medications which are centrally stored:(5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on observation and interview, medications are being pre-poured more than 24 hours in advance. LPAs interviews indicated that medication is pre-poured for five (5) days in advance. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 26, 2025

Plan of correction: Licensee agrees to cease pre-pouring medications immediately. Licensee shall submit a statement of understanding of this regulation.

Type of visit: Case Management - Legal/Non-compliance

On 04/14/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit. LPA met with Administrator Leriza Arambulo and explained the purpose of the visit. The purpose of this inspection is to follow-up on issues that were discussed in the Non- compliance meeting that took place on 11/18/2024. The facility is currently licensed for (6) non-ambulatory, hospice waiver of six (6). During today's visit, there are five (5) residents and one (1) resident receiving hospice services. During today's visit, LPA and Administrator toured the interior of the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety violation observed. LPA observed two (2) residents in common areas and (3) residents in their rooms. LPA compared medications to those being given for five (5) resident and found no discrepancies. As a result of today's inspection, no deficiencies cited. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: Required - 1 Year

On 01/08/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1 year annual inspection. LPA met with Administrator Leriza Arambulo and explained the purpose of the visit. LPA and administrator conducted a tour of the interior of the facility to ensure the health and safety of residents in care. Areas toured include but not limited to residents bedrooms, bathroom, kitchen and common areas. LPA observed facility to have required licensing posters. LPA observed medications, sharps, toxins to be locked and inaccessible to residents in care. LPA observed two (2) days of perishable and seven (7) days on nonperishable foods. LPA observed facility to be clean, sanitary and free of hazardous obstruction. Fire extinguisher was last serviced on 10/31/2024 LPA conducted file reviews for three (3) residents in care and two (2) personnel. LPA and Administrator discussed the outstanding licensing fee from 2024 to current. LPA and Administrator completed the CARE tool and deficiencies was observed. Please see LIC809-D. Exit interview conducted and a copy of the report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 8, 2025

Type of visit: Office

On 11/18/2024 at 10:30 AM, a Non-Compliance Conference was held at the Sacramento North Regional Office located at 9835 Goethe Road Suite 100, Sacramento CA 95827. The purpose of this meeting is to discuss the high volume of citations and a substantiated complaint. The following facilities are involved because they are owned by Licensee: BLESSED HOMECARE #342700911; BLESSED HOMECARE 2 ROSEVILLE # 315002812; and BLESSED HOMECARE 3 # 345920062. Present in the meeting was Licensee, Baby Quintero, Facility Representative, Leriza Arambulo, Regional Manager (RM) Alycia Rayner, Licensing Program Manager (LPM) Anthony Perez, LPM Troy Ordonez, Licensing Program Analyst (LPA) Cassandra Mikkelson, LPA Cassie Yang, LPA Cheyenne Ratajczak, and LPA Kerry Hiratsuka. Issues discussed during the meeting were: • High volume of Type A and Type B citations • Substantiated Complaint • Fire Safety issues • Supervision issues • Administrators lack oversight. • Reporting requirements • Communication breakdown • Criminal record clearance • Resident files are incomplete • Food service • Licensee not completing Plan of Correction correctly and timely • Licensee/Administrator accountability The licensee was in agreement with the drafted non-compliance plan as outlined in LIC 9111. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 18, 2024

Type of visit: Case Management - Other

On 10/30/24 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a case management visit. LPAs met with caregiver Leriza Arambulo and explained the purpose today's visit. Administrator Baby Ofelia Quintero was present at the facility for the first half of visit but had to leave and requested for caregiver to finish visit. At the time of LPAs visit, one resident was out of the facility at the doctors. LPAs conducted a file review of two (2) resident files. Both resident files are complete with required paperwork. LPAs observed R1 to be taking two (2) PRN medications that are not listed on their medication list. LPAs observed the facility to have a door stopper propping open the fire door in the hallway. LPAs also observed a fire extinguisher in the entry way of the facility that was last serviced on 01/25/23. LPAs also observed a fire extinguisher located in the residents hallway that was last serviced on 6/24/20. PRN medications that are not listed on Resident medication list is a repeated violation as the following deficiencies was cited during an annual inspection on 01/10/24. Deficiencies cited, civil penalties assessed. Exit interview and a copy of the report and appeal rights left at the facility.the state’s words, verbatim · CDSS document, Oct 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(c)(2)(A) · Plan of correction due date: Nov 13, 2024

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 1 out of 1 posters which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee will post the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) in a common area. Picture of the poster posted to be sent into CCL by 11/13/24 Failure to provide POC by due date may result to civil penalty of $100 per day until received.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(e) · Plan of correction due date: Nov 13, 2024

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in 1 out of 1 residents, PRN orders for Probiotics and Stomach Relief were not present in R1s file which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee will obtain PRN prescriptions for R1s Probiotic and Stomach Relief with correct dosage. Licensee will come up with a plan on how to ensure PRN prescriptions are documented on medication list. Failure to provide POC by due date may result to civil penalty of $100 per day until received.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Oct 31, 2024

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as LPAs observed facility fire door to be propped open with a door stopper and the fire extinguisher in hallway and entry way was last serviced on 06/24/20 and 01/25/23 which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee immediately closed fire door and stated that the facility will keep it closed. Licensee will send proof of service for both fire extinguishers to LPA. Failure to provide POC by due date may result to civil penalty of $100 per day until received.

Type of visit: Required - 1 Year

On 01/10/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Cassie Yang arrived unannounced at the facility to conduct a Required 1- year annual inspection utilizing the care tool. LPAs met with caregiver Leriza Arambulo and explained the purpose of the visit. LPAs and Caregiver conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: four residents room, two bathrooms, kitchen, storage area, and the common areas. LPA observed the facility to have 2+ days of perishable and 7+ days of nonperishable foods. LPAs observed seven bottles of PRN medication present in R1s room. LPAs conducted a file review of personnel and residents records. LPAs observed two personnel files to be incomplete with no annual training. One personnel file to be missing first aid training. LPAs observed resident records to be missing LIC501 and updated LIC602. LPAs additionally provided facility with LIC311f which states required documents for personnel and resident files. LPAs completed the full care tool and deficiencies was observed. Please see LIC 809-D. Exit interview conducted and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Jan 10, 2024

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.