Blissful Canyon Home Care II

Allegation investigated: Resident in care sustained unexplained injuries.

On March 04, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to the facility listed above. LPA met with staff Florence Groves, and the purpose of the visit was explained. LPA was granted entry to the facility. Later, LPA was joined by the Administrator (A1), Linda Orleans. LPA with Administrator toured the facility. The investigation consisted of the following: On March 04/2026, LPA Richard reviewed and obtained the Resident roster (dated 12/29/25) and the Staff roster (dated 10/15/25). LPA obtained copies of Resident #1(R1) Admission Agreement (Dated 06/26/22), Pre-Appraisal (dated 06/26/22), Physician report (dated 07/23/23), Medication Administration Records (MAR), and Identification and Emergency Information: facility notes, and Unusual Incident Injury report (dated 11/28/23). On March 04/2026, LPA Richard interviewed the Administrator (A1), two staff members (S1-S2), four residents (R2-R5), and the responsible party (W1). LPA obtained a copy of the death report of R1. Unsubstantiated Allegation: Resident in care sustained unexplained injuries. The complaint alleged that the resident has a draining laceration to the elbow and mentions pain in the right arm, shoulder, and four different fractures at different stages of healing. On March 4, 2026, LPA Richard interviewed the Administrator (A1), who denied the allegations. A1 explained that the resident (R1) had a history of falls before admission to the facility. On November 28, 2023, staff noticed that R1's right shoulder and hand were swollen and that red fluid was draining from the area. The staff called Emergency Medical Services (EMS), and R1 was transported to the hospital. A1 also mentioned that the facility has a fall-prevention program in place for all residents at risk of falls. On the same day, LPA interviewed two staff members (S1 and S2), who also denied the allegations. They stated that staff check on each resident every fifteen minutes, especially those who use walkers to move around. Additionally, LPA spoke with four residents (R2 to R5), all of whom reported that staff take good care of them and respond promptly when assistance is needed. LPA also interviewed the responsible party (W1), who denied the allegations, affirming that the facility staff takes excellent care of R1 and noted that R1 had a history of falls before being admitted to the facility. Report continued on LIC9099C On March 04, 2026, the LPA record review of the resident's appraisal dated 06, 22, 2022, showed R1 had a history of falls. LPA reviewed the Unusual Incident Injury Report that was sent to CCLD (dated 11/28/2023). LPA was unable to interview the Resident (R1), because R1 passed away in December 14, 2023. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. Exit interview conducted. A copy of the report was provided to the Administrator, Linda Orleans.the state’s words, verbatim · CDSS document, Mar 4, 2026 · control 18-AS-20231130084506

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) Yolanda Delgado and Toni Nwala arrived unannounced to conduct an annual inspection. Upon arrival LPA's was greeted by facility staff and granted entry by Cleotilde Reyes. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 110.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued on from Page 1) LPA began review of employee records- Three (3) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification; expires 10/07/2026. CPR and requirements have been met. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged. Smoke detectors and carbon monoxide detectors were tested and are operational. Fire extinguishers are tested or replaced annually and were last done so on 12/30/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 12/29/2025. Based on the information received during this visit today, zero (0) deficiencies are not being cited per Title 22, Division 6 of The California Code of Regulations. This LIC809 Report was reviewed with and a copy provided to the facility representative at the time of the exit interview.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Yolanda Delgado conducted a case management visit to clear deficiencies that were issued on 1/29/2025. There were no issues or concerns observed during the visit. There are six (6) clients that live at the facility and two (2) caregivers present. There are sufficient staff on duty. Deficiencies were cleared and copy was provided. A copy of this report was reviewed with the Caregiver and a copy was provided at the time of the exit interview. .the state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment-1 not signed by Medical professional and TB test results-1 missing, consent forms-1 missing, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is not meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 118.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. (Continued on next page) Continued on from Page 1) The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged however according to the approved floor plan LPA observed an enclosed patio arrange for caregivers room with two beds, chest drawers, clothing, lamp and an exterior shed in the back yard with a sink, commode, a twin bed, and clothing and no smoke detector installed. Smoke detectors (1) installed in the kitchen is not operational and carbon monoxide detectors were tested; not operational. Fire extinguishers are tested or replaced annually and were last done so on 01/4/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 01/25/2025. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there five (5) deficiencies with Civil Penalties for $500 being issued, cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D, LIC421IM, Appeal Rights was reviewed with and a copy provided to the facility representative at the time of the exit interview. LPA has requested updates to the following documents to be submitted to the CCL by 1/30/2025: Updated Facility sketchthe state’s words, verbatim · CDSS document, Jan 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Administrator, Rosalinda Orleans, who was informed of the purpose of the visit. At time of visit there were (6) clients and (3) staff present. The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. The facility does not have a pool or fire arms. The facility serves elderly ages 60 and above. LPA conducted a tour of the interior and exterior and reviewed facility documents. Infection Control: LPA observed hand hygiene supplies, PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a infection control plan on file. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The carbon monoxide detector was operational during the visit. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Record Review and Resident/Staff Files: LPA reviewed staff files and training that contained staff criminal clearance and updated training along with CPR/First Aid. Client files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in kitchen cabinet. LPA reviewed client medications and found that MARS log was not initialed for medication given or refused on today's date. Deficiency was documented and plan of correction was created. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last fire drill conducted on 12/18/2023 The documentation did not meet the department standards and technical note was documented. LPA observed all facility exits were clear from obstructions. An exit interview was conducted where a copy of this report, appeal rights and deficiency page were provided to Administrator, Rosalinda Orleansthe state’s words, verbatim · CDSS document, Jan 23, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Yolanda Delgado conducted a visit for complaint number 18-AS-20231130084506 and during the visit, LPA reviewed documents, interviewed staff and toured the facility and it was revealed that Staff #1 (S1) did not have criminal background clearance and was not associated to the facility. LPA observed a wood glass coffee table blocking a passage way. There are working utilities, sufficient staffing and sufficient groceries for residents. The following is being cited: Title 22, Division 6, Chapter 8, Article 05, Section s 87307(a)(6) and 87355(b). The report was reviewed with Rosalinda and a copy of this report, LIC809D, LIC421BG, and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Dec 6, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b) · Plan of correction due date: Dec 7, 2023

Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by: Based on observation and interviews, the Licensee did not comply with the above regulation with one staff (S1). LPA Delgado learned that S1 does not have a criminal record clearance and is not associated to this facility. This is an immediate safety risk to all residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2023

Plan of correction: Licensee agrees to complete and submit the LIC9182 by 12/7/2023 in order for S1 to return at the facility. Licensee to provide LPA Delgado with proof of submitted request by 5pm on the due date indicated.

From the deficiency page — Deficiency type: Type B · Section cited: HSC87307(a)(6) · Plan of correction due date: Dec 6, 2023

Personal Accommodations: (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.Based on observation and interviews, the Licensee did not comply with the above regulation with a wood glass table pushed up to the front door of facility to block a resident from leaving. This is an immediate safety risk to all residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2023

Plan of correction: Licensee agrees to speak with staff and during the visit, staff moved the coffee table from obstructing the passage way.