Blissful Care Home

Type of visit: Required - 1 Year

At approximately 9:20 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Claribelle Bailon was not at the facility during the inspection due to a prior engagement. Blissful Care Home is Licensed as a Residential Care Facility for thee Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were four (4) residents in care and two (2) staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:40 AM, LPA toured the facility with Caregive Olayvar. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged 2/18/2026. The facility was sufficiently lighted. LPA inspected five (5) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. The facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 4/2/2026. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. The facility's smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:20 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed with all required documentation. LPA reviewed five (5) staff files. One (1) of five (5) files (for staff member S1) was observed not to have proof of required annual training. This deficiency will be cited. Four (4) of five (5) staff files were observed with all required documentation. LPA audited Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Claribelle Bailon’s Administrator Certification 7032509740 is current with an expiration date of 6/26/2027. LPA requested the following documents be submitted to Community Care Licensing by 5/26/2026: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Caregiver Olayvar. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 12, 2026

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

At approximately 12:15 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to continue a required 1-year annual inspection and was greeted by caregiver Alexander Olayvar Facility is a Residential Care Facility for the Elderly (RCFE) licensed for 6 residents with five (5) residents in care. Facility has a Hospice waiver for two (2), with 2 hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 12:40 PM Administrator/Licensee -Claribelle Bailon arrived. At approximately 12:45 PM, LPA reviewed Client and Staff Files. All files were all found to be well organized, thorough and contained the required documentation. Facility does not do P&I monies for clients. At approximately 1:45PM LPA and Licensee Bailon conducted a spot check of medication and medication records with records observed to be accurately kept. Medications were observed to be centrally stored and locked. Licensee/Administrator to submit updates of the following documents by 05/04/2025 LIC 500 Personnel Summary LIC 610D Emergency Disaster Plan LIC 308 Designation of Facility responsibility (was obtained during today's inspection) No deficiencies were cited todaythe state’s words, verbatim · CDSS document, Apr 4, 2025

Type of visit: Required - 1 Year

At approximately 1:45 PM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to begin a required 1-year annual inspection and was greeted by caregiver Alexander Olayvar Facility is a Residential Care Facility for the Elderly (RCFE) licensed for 6 residents with five (5) residents in care. Facility has a Hospice waiver for two (2), with 2 hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 02:00 PM Administrator/Licensee -Claribelle Bailon arrived. At approximately 02:05 PM, LPA initiated a tour of the facility with licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 02/2025 and were observed to be fully charged . Water temperatures measured 114.2F and 115.8F. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Two (2) staff areas noted on the facility sketch with one (1) staff member noted to have personal meds in a locked box in a staff room. No firearms are in the home. LPA observed at least a 2-day supply of a variety of healthy and perishable foods, 7-day supply of non-perishable food, and emergency water supplies. In addition, a variety of snacks and fruits were observed to be set out for residents. Food was found to be stored in a safe manner with open items covered and date. Continued 809C... Continued from 809... LPA observed TVs, books, patio with ramps, seating and sunshade accessible to residents. Disaster drills were last conducted March 2025 Three (3) of (3) staff members present were associated to the house through Guardian. No deficiencies cited today and LPA will return at a later date to complete the required annual inspection.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Pre-Licensing Inspection and met with Applicant/Administrator, Claribelle Bailon. Applicant has applied for a Change of Ownership at this location and currently has 6 residents in care. Facility is a one story residence with five resident bedrooms, 2 bathrooms, living room, dining room, kitchen area, two staff bedrooms and the garage. All resident rooms have the required furnishings in resident bedrooms. Bathroom showers have non-skid shower floors/mats and grab bars. Water temperature in bathrooms is within regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. The refrigerator was observed to be clean and there was plenty of perishable and Non perishable foods that appeared in good condition and stored properly. Cleaning supplies are locked under kitchen sink and locked. Sharps are located in kitchen drawer and locked. Personnel records and resident records are stored in locked cabinet. Medication is centrally stored and locked. Facility received an approved fire clearance dated February 15, 2024Bli that allows for 6 non-ambulatory residents. Carbon monoxide and smoke alarms are operational. Fire extinguisher is charged and service 2/2024. Required postings were observed, including a copy of the Admission Agreement. Auditory alarms on doors were operational. Applicant to submit copy of Liability Insurance to Centralized Applications Bureau Analyst Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulation. Component III was conducted today, with Applicant, Claribelle Bailon. Pre-Licensing is complete. No citations issued.the state’s words, verbatim · CDSS document, May 6, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Bailon, Claribelle - Applicant/Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 03/07/2024, 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, Mar 7, 2024