Almond Blossom Care Home

Type of visit: Prelicensing

Licensing Program Analyst, LPA, Noel Wolf peteresn arrived announced to the facility at 8:30 and met with administrator Rolj Jylan "RJ" Vergara and corperate board member Rolondo Vergara to explain the purpose of the visit: to conduct a prelicensing inspection. Almond Blossom Care Home is intended to provide services for 6 ambulatory clients over age 60+. Comp 3 presentation was given. Physcial inspection of the plant included but was not limited to: the kitchen, bedrooms, bathrooms, common areas, exteriors, and evacuation route gate. the facility is clean, the traffic areas are well lit and unobstructed. The kitchen has adequate space for storing toxics, sharps, and medications. The kitchen has food storage capacity for 2 days perishable and 7 days non perishable. LPA asked the adminstrator to remove a lock from the refridgerator doors. The bedrooms have required furniture and furnishings excepting mattress encasements. LPA asked for the administrator to furnish the matteresses with encasements. The Bathrooms have functional hardware, the bathroom sink measured between 110-115*F. The common areas and exteriors have space for activities, the LPA made a suggestion to have more outdoor indoor seating as to accomodate all 6 residents at once. The evacuation route gate swings freely and latches closed, LPA asked for the adminstrator to remove all locks on gates designated on the facility sketch for evacuation. There is a hot tub, the hot tub is empty of water and secured as to need tools to access it. LPA asked for the hot tub to remain secured and unused unless and until the facility was compliant with all regulation for its use. LPA reviewed the evacuation plan and infection control plan, Files are present and up to date. Required postings postered, first aid kit has all required items, extinguishers are dated april 14 2026 and smoke alarm and CO alarm are functional. No objections to licensure at this time. a copy of the report was read and given to the administrator. exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 4, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: VERGARA, ROLJ JYLAN Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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, Jul 14, 2026

Type of visit: Prelicensing

On June 10, 2026, at 9:15am ,Licensing Program Analyst's (LPA's) Melina Oropeza and Avelina Martinez arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA's met with Linsday Moffatt, and explained the purpose of the visit. Facility has a fire clearance for six non-ambulatory residents. The facility Administrator has a current certificate. The facility has an approved hospice waiver for six. . LPA's inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. LPA's inspected the facility on June 10, 2026, with facility staff member, Linsday Moffatt. LPA's inspected all six bedrooms that were furnished and sanitary. The facility temperature measured at 76 degrees and the facility water temperature measured at 106 degrees. All common areas of the facility were sanitary and furnished. The facility kitchen had adequate food supply and was sanitary. The facility has a public telephone for residents use and the facility has an area for activities. The facility has a laundry room with a sufficient supply of linens. LPA's inspected the smoke/carbon detectors, fire extinguisher that was inspected on June 8, 2026. The facility has a first aid kit. The medications are stored in a locked cabinet. The exterior emergency gate is in good repair and clear of any debris. The facility has a large body of water. The swimming pool is secured and is secured by a six foot locked fence. The exterior of the facility is clear of debris and is sanitary. The facility has a designated shaded furnished patio for resident use. The facility has implemented employee and resident files. The facility has an Infection control plan and natural disaster plan. The facility has a emergency drill log, freezer and temperature log. continued... The applicant has passed the pre-licensing component of the application process. LPA Oropeza conducted Component III with applicant. LPA Oropeza will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was provided to the applicant.the state’s words, verbatim · CDSS document, Jun 10, 2026