A Place of Bliss

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff and administrator joined 15 minutes later. LPA explained the purpose of the visit to Administrator and staff. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 6. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the care tool. No bodies of water were observed at the facility. Hot water temperature was measured at 105 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 07/14/2025 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Case Management - Incident

LPA Kesha Lewis conducted a unannounced case management visit. LPA met with caregiver, who contacted Administrator. LPA spoke to Administrator on the phone and explained the purpose of today's visit. During today's inspection, The purpose of today's visit is to follow up on a incident report that was sent to the facility to the department on 08/19/25. The SIR was regarding R1 going AWOL from the facility on 8/12/2025. R1 had left the facility and staff were not aware R1 was gone. R1 was found two (2) hours later at a store trying to make a purchase. R1 is able to leave the facility unassisted. The facility plans to increase monitoring of R1. Exit interview conducted and copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Sep 22, 2025

Allegation investigated: Facility staff took inappropriate photo of resident

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver complaint findings for the above allegation. LPA was greeted licensee and explained the reason for the visit. Allegation 1 Facility staff took inappropriate photo of resident is SUBSTANTIATED. Based on LPA interviews with reporting party, S1 and adminstrator, LPA found the allegation was true, R1'S responsible party was not asked and did not give approval for photos to be taken of R1. The Department has investigated the complaint listed above and based on the investigative interviews, record reviews and other supportive evidence, the complaint is determined to be SUBSTANTIATED. As a result, the preponderance of evidence standard for this allegation is met, therefore, this allegation is SUBSTANTIATED.the state’s words, verbatim · CDSS document, Apr 2, 2025 · control 27-AS-20250303092730

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80071(a)(1) · Plan of correction due date: Apr 14, 2025

Each client shall have personal rights which include, but are not limited to, the following:..To be accorded dignity in his/her personal relationships …To be accorded safe, healthful and comfortable accommodations…This requirement was not met as evidenced by: Based on interviews, staff confirmed approval was not gained prior to taking the photo. which poses a potintial Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: staff will complete mandated training with a focus on privacy. Administrator will email proof of training to LPA by COB 04/14/2025.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA explained the purpose of the visit to staff. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 4. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals not locked (photos taken) and medications noted to be locked to residents in care. LPA also conducted the care tool. No bodies of water were observed at the facility. Hot water temperature was measured at 108 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 07/8/2024 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed four (4) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Defiencies are being cited during todays visit see 809D page. Exit interview held with staff and copies of reports and appeal rights given.the state’s words, verbatim · CDSS document, Nov 5, 2024

Type of visit: Post Licensing

On 2-7-2024, Licensing Program Analyst (LPA) Kesha Lewis arrived at this facility unannounced to conduct a post inspection visit. LPA met with the administrator and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an RESIDENTIAL CARE for the ELDERLY with a current census of 3. Facility has 4 bedrooms and 3 bathrooms for resident use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 2 ambulatory resident, 1 non ambulatory residents, 1 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 110*F to 120*F in the bathroom. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 11-17-23. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 3 resident file and 1 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training requirements. All staff noted on LIC 500 contained criminal background clearances. LPA provided licensee with resources the LIC 858 and 859 checklists. Exit interview and report provided.the state’s words, verbatim · CDSS document, Feb 7, 2024

Type of visit: Prelicensing

On 10/26/2023, Licensing Program Analyst (LPA) Kesha Lewis arrived announced to conduct a Pre-Licensing visit. LPA was greeted by applicants, and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit. This facility will be licensed to hold 6 residents, of which 6 may be non-ambulatory, and a Hospice wavier for two (2). A tour of the facility was conducted. Smoke detectors and carbon monoxide detectors were tested and are in good repair. A tour of the kitchen area was toured. A review of food supply was conducted to ensure a 2 day perishable and 7 day non-perishable food supply was available. This facility will have a locked medication cabinet located in entrance hallway. A first aid kit was observed and had all the required components. Fire extinguisher was located in kitchen and was serviced on 06/23/2023 by the local fire company. A tour of the family room was conducted. Furniture and furnishings were observed to be in good repair. A tour of the backyard was conducted with no hazards present. Perimeter gate was observed to be in good repair. A tour of garage was conducted. A washer and dryer was identified. in the laundry room Detergent, toxins and other cleaning supplies were observed to be locked and made inaccessible. A tour of the resident bedrooms were conducted. Furniture and furnishing were observed to meet the residents needs. A linen closet was located in hallway and was observed to have a sufficient amount of linen to meet the residents needs at this time. Hot water temperature was taken to ensure that it was in within 105-120 degrees.the state’s words, verbatim · CDSS document, Nov 2, 2023