Blossom Creeks Assisted Living 2

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today (January 21, 2026) for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Rajvinder Samra. Facility is licensed for 6 residents and has a current census of 5. Facility has 4 bedrooms and 2.5 bathrooms. One bedroom is for staff, and the other three bedrooms are for residents. Currently 2 bedrooms are shared, and one resident has their own room. Facility Water temperature was checked in the kitchen which read at 111.9 degrees Fahrenheit and in the common bathroom which read at 109.0 degrees Fahrenheit. Fire Extinguisher was serviced February 4, 2025, and has correct charge. Smoke and carbon monoxide detectors were tested and in working order. There is 1 resident currently on hospice. R1 is currently on oxygen. Facility did not obtain approval from the Dept to retain R1 who has a restricted health condition. The facility did not report to the local fire dept in writing regarding R1 being on oxygen. Rajvinder Samra Administrator's Certification expires August 9, 2026. Staff files were reviewed. Resident files were reviewed, complete, and current. Physician reports are current and do not indicate residents are at risk for elopement or hygiene products are a danger. Facility provided a log for disaster drills that are conducted quarterly. First aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. There is a locked storage for medications. LPA inspected the exterior and interior of the facility, including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. Observed deficiencies were cited during today's inspection per California Code of Regulations, Title 22. Exit interview was conducted and a copy of this report LIC809, LIC 809D, and appeal rights were provided to Administrator Rajvinder Samra.the state’s words, verbatim · CDSS document, Jan 21, 2026

Allegation investigated: Facility has pests Facility staff were not assisting R1 with ADL's Staff handled resident in a rough manner Facility did not properly care for residents restricted health condition

On January 27, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced complaint investigation visit to the facility for the purpose of delivering investigation findings regarding the above allegations. LPA was met by Sukhwinder Kaur, Caregiver who contacted administrator who gave permission to sign the forms. The Department has investigated the complaints alleging: Facility has pests; staff were not assisting with ADL's; Staff handled a resident roughly, and facility did not properly care for a resident with restricted health condition. Based on the interviews conducted and/or records review the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. A copy of this report along with appeal rights will be emailed to Administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 27, 2025 · control 24-AS-20241011140047

Type of visit: Required - 1 Year

On 1/21/2025, Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced to conduct the Annual inspection. LPA was allowed entrance by Direct Care Staff, Sukhwinder 'Sonia' Kaur. Administrator, Rajvinder Samra (AD) arrived shortly thereafter. LPA explained the purpose of the visit and a tour of the facility, both inside and out was provided by AD. The facility currently has 3 residents with a capacity of 6. LPA observed required items in bathrooms with hot water measuring 114.5 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured and observed in good repair with necessary items and appliances, and sharps/knives were stored in lockable drawer. LPA observed required food supply, including emergency food buckets and paper products. AD has a dedicated cabinet for medications and a lock box for refrigerated medications. Medical dispensing records are computerized and meet regulation. LPA reviewed both staff and resident files. No issues noted, all required documentation was present and in compliance. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kit located in kitchen cabinet and found to contain required items. Two fire extinguishers located in facility (hallway and kitchen) and were serviced in February 2024 by Valley Fire. Smoke and Carbon Monoxide detectors were tested and found to be operational. Administrator’s certification current and confirmed to be in active status. A copy of this report and exit interview conducted with AD. A copy of this document will be sent via email to administrator.the state’s words, verbatim · CDSS document, Jan 21, 2025

Type of visit: Case Management - Incident

On 10/26/2024, Licensing Program Analyst (LPA) R Bruce, arrived at the facility for an unannounced case management and met with Rajvinder Samra, Administrator. The purpose of the visit was to discuss recent incident reports and when it is appropriate to send a report. Discussion was held regarding a recent resident (no longer at the house) who would call emergency services on a consistent basis when not necessary. LPA explained the necessity of reporting anytime law enforcement is at the house, also it is necessary to report any change in medical condition, anytime they go to the hospital, any change in level of care etc. Administrator will speak with staff on how and when to report and continue to review the reports before submitting. No deficiencies issued at today's visit.the state’s words, verbatim · CDSS document, Oct 16, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA met with Administrator Rajvinder Samra (AD) and explained the purpose of the visit. Facility was toured with AD. During this visit, LPA toured the facility inside & out. There are no residents currently residing in this facility. LPA observed required items in bathrooms with hot water measuring 114.5 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were stored in lockable drawer. LPA observed required food supply, including emergency food buckets and paper products. AD has a dedicated cabinet for medications and a lock box for refrigerated medications. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kit located in kitchen cabinet and found to contain required items. Two fire extinguishers located in facility (hallway and kitchen) and were serviced in Dec 2022. Smoke and Carbon Monoxide detectors were tested and found to be operational. Administrator’s re-certification was confirmed to be in active status. AD is requesting 1 bedridden room Fire Clearance. LPA will submit necessary paperwork. A copy of this report and exit interview conducted with AD. LPA is requesting the following documents be submitted to the Fresno CCL office by 2/9/2024. Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E).the state’s words, verbatim · CDSS document, Jan 26, 2024