Blissful Grannies Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual inspection. LPA met with administrator Johnna Udden and explained the reason for the visit. The LPA and Administrator conducted a physical plant tour inside and outside to ensure there were not health and safety hazards and the facility is in compliance with Title 22 Regulations. The smoke detectors and carbon monoxide were tested and functioned properly. The fire extinguisher appeared fully charged and was recently purchased in January 08, 2026. Common Areas: Common seating area and dining room furniture were observed to be in good condition. Kitchen: Knives are stored in a locked cabinet drawer. Cleaning supplies were stored in a locked cabinet under the sink. Appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Bedrooms: There are four bedrooms for residents. Two are two shared rooms and two are private. All bedrooms were appropriately furnished, had sufficient lighting and clean linens. Bathrooms: There is one bathroom in the hallway and one bathroom for private use in the shared main bedroom. Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels and soap were available for hand washing. The hot water temperature was tested in the private bathrooms and measured 107.4*F. Report will continue on LIC809-C, 2nd page. Outdoor Space: Backyard has a covered outdoor area equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked and self-latching. Records: Record review was initiated at 11:40 a.m. Facility records are stored in the locked cabinet inside a locked office in the gara. The LPA observed documentation of Infection Control, Disaster prevention, Insurance Liability and last Disaster drill (conducted on 02/02/2026). The LPA reviewed records for five (5) out of five (5) residents, and six (6) out of six (6) staff including the administrator. All documents reviewed were complete. Medication: A Medications review for two (2) residents was conducted.; medications are centrally stored and locked in a cabinet in the dining room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. Interviews: LPA conducted interviews with two (2) residents and two (2) staff; no concerns noted. No citations were issued. Exit interview was conducted and report was issued to the administrator.the state’s words, verbatim · CDSS document, Feb 27, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual inspection. LPA met with administrator Johnna Udden and explained the reason for the visit. Records: Record review was initiated at 8:30 a.m. Facility records are stored in the locked cabinet inside a locked office. The LPA observed documentation of Infection Control, Disaster prevention, Insurance Liability and last Disaster drill (conducted on 02/08/2025). The LPA reviewed records for five (5) out of six (6) residents, three staff and two administrators. All documents reviewed were complete. Medication: Medications review for three (3) residents began at 09:30 a.m.; medications are centrally stored and locked in a cabinet in the dining room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. At 09:55 a.m. the LPA and Administrator conducted a physical plant tour inside and outside to ensure there were not health and safety hazards and the facility is in compliance with Title 22 Regulations. The smoke detectors and carbon monoxide were tested and functioned properly. The fire extinguisher appeared fully charged and was recently purchased in February 21, 2025. Common Areas: Common seating area and dining room furniture were observed to be in good condition. Kitchen: Knives are stored in a locked cabinet drawer. Cleaning supplies were stored in a locked cabinet under the sink. Appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Report will continue on LIC809-C, 2nd page. Bedrooms: There are four bedrooms for residents. Two are shared rooms and two are private. All bedrooms were appropriately furnished, had sufficient lighting and clean linens. Bathrooms: There is one bathroom in the hallway and one bathroom for private use in the shared main bedroom. Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels and soap were available for hand washing. The hot water temperature was tested in the bathrooms and ranged between 110.3*F - 113.5*F. Outdoor Space: Backyard has a covered outdoor area equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked and self-latching. Interviews: LPA conducted interviews with three (3) residents and two (2) staff; no concerns noted. No citations were issued. Exit interview was conducted and report was issued to the administrator.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual inspection. LPA met with administrator Johnna Udden and explained the reason for the visit. LPA conducted a physical plant tour inside and outside to ensure there were not health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke detectors were tested and functioned properly. The fire extinguisher appeared fully charged and was recently purchased in March 2024. The hot water temperature was tested in the bathrooms and ranged between 108.5*F - 111.9*F. Infection Control: Upon entry, the facility has a sign in book and sanitizing gel. Infection Control signage was observed. The facility has a sufficient supply of Personal Protective Equipment (PPE) and can obtain more if needed. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate. Common Areas: Common seating area and dining room furniture were observed to be in good condition. Kitchen: Knives are stored in a locked cabinet drawer. Cleaning supplies were stored in a locked cabinet under the sink. Appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Bedrooms: There are four bedrooms for residents. Two are shared rooms and two are private. All bedrooms were appropriately furnished, had sufficient lighting and clean linens. (continued on LIC809C) (continued from 809) Bathrooms: There is one bathroom in the hallway and one bathroom for private use in the shared main bedroom. Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels and soap were available for hand washing. Outdoor Space: Backyard has a covered outdoor area equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked and self-latching. Medication: LPA reviewed medications, including PRN medications, which appeared to be given as prescribed. Interviews: LPA conducted interviews with two staff; no concerns noted. LPA was unable to interview residents due to their medical conditions. Records: LPA reviewed records for five residents, three staff and two administrators. All documents reviewed were complete. No citations were issued. Exit interview was conducted and report was issued to the administrator.the state’s words, verbatim · CDSS document, Mar 8, 2024

Allegation investigated: Staff hit resident

Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced subsequent complaint visit for the above allegation. The LPA arrived at 11:00 a.m., met with staff and informed them for the reason of the visit. Administrators Johnna Udden and Helen Busch arrived shortly. On 06/02/2022, between 10:26 a.m. and 10:32 a.m., LPA Peraldi along with the Administrator, conducted a physical plant tour. At 10:01 a.m., the LPA conducted an interview with the Administrator and staff. Between 11:33 a.m. and 11:40 a.m., the LPA interviewed residents. The LPA also reviewed records at 10:35 a.m. and obtained copies of pertinent documents. During today’s visit, LPA Cortez along with Care Giver Rebeche toured the facility at 11:12 a.m., interviewed staff, residents, Resident #1 (R1) family member, and hospice social director between 1:05 p.m. and 3:20 p.m., and collected pertinent documents. Report will continue on LIC9099-C. Unsubstantiated It was alleged that Staff hit resident. It was further reported that staff slap Resident #1 (R1) and covered R1’s mouth. Information gathered revealed that there has not been any residents report of being hit by any staff. Staff interviews revealed that the residents have never voiced any concerns about staff hitting them, and if they did, they would report it. Staff interviews revealed there was an incident where R1 was being showered by their Home Health bath aid, and two staff (S1,S2) heard R1 screaming and went to assist. S1 started to pat R1 on their back to calm R1 down and denies slapping R1. R1 started to spit. S1 stated they placed their hands close to R1’s face to cover themselves from the spit and denied covering R1’s mouth. S2 revealed they were present during the incident and denied observing S1 slap or cover R1’s mouth. Administrator further stated they had a meeting with the hospice agency, and R1’s family members regarding the incident. Interview with Hospice Social director revealed that the incident had been discussed during a meeting, the facility denied any claims of abuse and no other issues regarding staff were on file. On 6/02/22 LPA Peraldi interviewed R1, who stated the facility was okay and that staff was okay. LPA Peraldi also interviewed a separate resident who stated staff are fine. On 1/31/24 LPA Cortez interviewed two (2) residents who denied ever observing staff hit residents and stated they have no concerns and feel safe at the facility. In addition, the Interview, LPA Cortez conducted with R1’s family revealed that they are very happy with the care the facility provided to R1. R1’s family also revealed that R1 was visited by family weekly and they did not have any concerns, and stated staff did not hit R1. Furthermore, R1’s family stated that they had a concern with R1’s bather and after they were replaced, they never had a problem. Based on information gathered during the course of the investigation, there is insufficient evidence to support the allegation, “Staff hit resident”. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 31, 2024 · control 29-AS-20220531120218

Type of visit: Case Management - Deficiencies

Analyst (LPA) Esther Cortez conducted a case management - deficiencies visit inspection due to a deficiency observed during the investigation of complaint control #29-AS-20220531120218 The LPA met with Administrator Johnna Udden and explained the reason for report. During the complaint investigation, the following deficiencies were observed: During today's visit, LPA observed Lysol wipes in Rm3, the kitchen counter, and in the unlocked laundry room accessible to residents in care. At 11:18 a.m. the LPA observed an unlocked shed in the back yard with a bed, grooming/hygiene items, clothing, a purse, a box of Amoxicillin 500mg capsules, a box of AZO urinary pain relief maximum strength tablets, and small cans of paint accessible to residents in care. At 1:36 p.m., the LPA observed, grooming/hygiene items, vapor rub, Lysol wipes, a bottle of 10% povidone-iodone solution, wound cleanser, and a tube of Phytoplex protectant Z-guard paste in room 3. Resident in room 3 cannot manage their own medication and is at risk if allowed direct access to personal grooming and hygiene items per their LIC602. Facility serves residents with Dementia. Citations Issued. See LIC 809-D. Appeal Rights discussed and copy of report issued.the state’s words, verbatim · CDSS document, Jan 31, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Feb 1, 2024

87705 (f)(2) Care of Persons with Dementia. The Following shall be stored inaccessible…:over the counter medication,…toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidenced by: Based on LPA's observations, the licensee did not comply with the section cited above as over the counter medications, and toxic substances were observed at the facility accessible to residents which posed an immediate health risk to residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: POC has been cleared. Administrator locked the shed and removed all items from room 3 and disinfectant wipes and stored all items inacceble to residents in care during the visit..

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a)(B) · Plan of correction due date: Feb 5, 2024

87307(a)(B) Personal Accommodations and Services Living accommodations... shall ... provide...privacy for the residents, staff...(B) No room commonly used for other purposes shall be used as a sleeping room...This requirement is not met as evidenced by: Based on observation, the licensee failed to ensure that common areas were used appropriately, LPA observed a bed, and personal items in the she which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: The Administrator has agreed to do the following: Submit proof the shed has been cleaned out and only use for storage. Submit by 2/05/2024.