Blossom Creeks Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator Rajvindeer Sarma. During this visit, LPA Brown toured the facility inside and out with AD. Required postings were hung as required. Resident rooms and common areas were clean, in good repair containing required furnishings and lighting. LPA observed required items in bathrooms which were clean with hot water measuring 108 degrees. LPA observed hygiene items, paper products, towels, extra bedding, and linens which were available for use. The kitchen was clean, containing necessary cooking items and appliances. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separately from food. LPA observed required food supply, including emergency food and supplies. Medications are centrally stored and securely locked in a kitchen cabinet. Doors and passageways are unobstructed throughout the facility, including outdoors. LPA walked outside to find the grounds well-kept with patio and welcoming covered seating areas. Fire extinguishers were serviced 3/12/26 by Valley Fire Co. During this visit, LPA conducted resident and staff file reviews including a medication audit. Infection Control and Emergency/Disaster Plans & procedures were reviewed. There were no citations during this inspection. An exit interview was conducted and a copy of this report was signed and provided LPA requested the following updated forms faxed to CCLD by 8/9/2026- Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Client Roster (LIC 9020) and Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Sep 2, 2026

Type of visit: Required - 1 Year

On 8/26/25 Licensing Program Analyst (LPA), M. Garza completed an unannounced annual visit. LPA observed the facility to be empty and under construction. LPA contacted Licensee, Rajvinder Samra, who stated they were under renovations still. LPA informed Licensee the annual still needed to be conducted. Licensee arrived some time later. LPA toured the facility inside and out. No or staff present during todays visit. Currently there are no resident living at the facility. LPA observed the home to be under construction. Walls were to the studs in most areas. Per Licensee they are in the process of placing a new fire system into the facility. Anticipated completion date of construction is at the end of October 2025. No deficiencies cited during todays visit. LPA requested the following documents to be submitted to CCL by 9/5/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), in order to update the facility file. Exit interview was conducted with Licensee, Rajvinder. A copy of this report was discussed and provided to Licensee.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Case Management - Annual Continuation

On 9/10/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to continue the annual inspection. LPA introduced herself and was allowed entrance by staff. Licensee Rajvinder Samra was contacted and arrived at the facility shortly after. LPA reviewed medication for R1, centrally stored log and PRN log did not match for Benzonatate oral pill 100 mg capsule. PRN log total was 21, MARs showed medication was also given in August but was not marked on the PRN log. Amlodine oral pill 5 mg tablet was logged as starting 8/21/24, there was 21 marked as taken, and there are 10 remaining in the bottle, which totals 31 pills, the quantity on the medication is 30. When LPA arrived and reviewed the MARs it did not indicate AM medications were given. Citation issued for Centrally stored medication log and PRN log not being kept maintained. Licensee explained due to having the facility sprayed for pests non-perishable food was removed and limited food was kept at the facility in order to not contaminate. LPA accepted the explanation for limited food at the facility. Licensee also explained this is the last week at the facility while renovations are taking place. LPA informed Licensee to submit an incident report and verification of building permits. Licensee stated they will be increasing their capacity to 12 after the renovations, LPA informed Licensee there needs to be documents submitted to request the increase. Citation was issued for the pest/insect control issue from the 8/17/2024 visit. Citation was also issued due to emergency exits not opening properly. LPA reviewed a sample of resident files which are current except for R1's PRN blank prescription form. A sample of staff files was also reviewed which is current and up to date. Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Licensee Rajvinder Samra.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Required - 1 Year

On 8/17/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct an annual inspection. LPA introduced herself to Direct Care Staff Rogelio Negrete and explained the purpose of the visit, LPA was granted entrance into the facility, and Licensee/Administrator Rajvinder Samra was contact and informed of the reason of the unannounced visit. Licensee/Administrator stated they would not be able to attend the annual inspection. LPA toured the facility inside and out including kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPA observed the facility to be at a comfortable temperature, clutter free and odor free. LPA observed exit passageways to be clear however LPA observed the exit from the master bedroom to be stuck and difficult to open, and the exit door inside the garage to be stuck and difficult to open. This creates an obstruction of the exits. Facility has 2 residents with a diagnosis of dementia, the exits did not have an audio alarm on the exits. Emergency phones numbers were observed in the facility. Facility capacity is 6, with a current census of 5. Facility has 4 bedrooms and 3 bathrooms. Resident’s share bedrooms. Facility has live-in staff which have their own bedroom and bathroom which are kept locked an inaccessible to residents. Fire extinguishers were observed to be last serviced on 6/7/2024 and are in good standing with charge. Smoke detectors and carbon monoxide detectors were tested and are in working condition. Water temperature was checked in a shared bathroom between resident bedrooms and read at 105.6 degrees Fahrenheit. Water was also checked in the kitchen which read at 105.4 degrees Fahrenheit. Inspecting kitchen LPA did not observed the required 7-day supply of non-perishable food or 2- day supply of fresh perishables food items to be properly stored. LPA observed insects throughout the kitchen. Knives & cleaning supplies were observed to be locked and inaccessible to residents. LPA is requesting the following documents be submitted to the Fresno CCL office by 08/30/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A). A follow-up visit will be conducted at a later date to review resident files, staff files, and other documents. The documents were not available at this time due to Licensee/Administrator not available and documents not being kept at the facility or staff not having access. Deficiencies will be cited at the follow-up visit. Exit interview was conducted and a copy of this report LIC809 was provided to Staff Rogelio Negrete.the state’s words, verbatim · CDSS document, Aug 17, 2024

Allegation investigated: Neglect/ lack of care and/or supervision resulting in resident's injury.

Licensing Program Analyst (LPA) L. Padgett conducted an unannounced complaint visit. LPA met with Administrator Rajvinder Samra and explained the purpose of this visit was to deliver the findings of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. Per records review, Resident (R1) was admitted to a hospital and diagnosed with a variety of illnesses and the x-rays yielded three fractures including an old left femur fracture, and new left distal femur and right oblique spiral fracture. It was reported that R1 had sustained a prior femur fracture at the facility. However, a medical records review of the prior hospitalization did not yield any fractures. Interviews with the facility administrators and caregivers did not provide an explanation for the R1’s fractures. They denied any falls, injuries, or physical abuse. Based on the interviews conducted and records review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 28, 2024 · control 24-AS-20231221100747