Blossom Grove Alzheimer's Special Care Center

Allegation investigated: Staff are leaving the resident soiled in urine or feces

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver the investigative findings. Upon arrival, LPA met with Facility Administrator Sadaf Roodbaie and explained the purpose of the visit, which was to discuss the investigative findings regarding the allegation that is stated above. First Allegation: Staff are leaving the resident soiled in urine or feces. Regarding the above allegation, LPA conducted a review of records pertaining to Resident #1 (R#1). Review of R#1’s Physician’s Report indicates that R#1 has bowel and bladder incontinence. LPA also reviewed R#1’s Needs and Services Plan, which indicates that R#1 is to be changed every two hours and as needed due to bowel and bladder incontinence. LPA conducted an inspection of R#1’s room. The room was observed to be clean and free of excremental odors. R#1 was observed to be clean and well groomed. LPA also observed that R#1’s hygiene was maintained. LPA interviewed Staff #1 (S#1) regarding the allegation that R#1 was being left soiled in urine and feces. S#1 denied the allegation and stated that R#1 is changed every two hours and as needed due to R#1’s bowel and bladder incontinence. Unsubstantiated S#1 denied observing staff leave R#1 soiled in urine or feces for an extended period of time. LPA reviewed the facility’s staff rosters and observed that the facility had sufficient staffing to meet the needs of the residents in care. Based on the evidence obtained during the course of the investigation, LPA determined that the allegation is Unsubstantiated. An allegation is determined to be “Unsubstantiated” when the evidence obtained during the investigation does not establish, by a preponderance of the evidence, that the alleged violation occurred. Although the allegation may have occurred or may be valid, the evidence obtained during the investigation was insufficient to establish that the alleged violation occurred. An exit interview was conducted where LIC 9099 report was discussed and provided to Facility Administrator Sadaf Roodbaie at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 22, 2026 · control 56-AS-20260616105546

Type of visit: Prelicensing

Licensing Program Analyst (LPA) E. Conchas conducted an announced visit to the pending facility for the pre-licensing inspection. LPA met with the Executive Director, Sadaf Roodbaei and Clinical SVP, Donna Kimura. The pending application is for 66 bedridden residents in a Residential Care Facility for the Elderly. LPA toured the property inside and out. The following was observed, reviewed, and inspected: There are no bodies of water. The physical plant, in general, was in good repair. Buildings and grounds are free from hazards. Indoor and outdoor passageways are free of obstruction. There are charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. There is a locked area for medications and cleaning supplies. LPA observed a working telephone and basic laundry equipment. Resident bedrooms had the required bedding and furniture. Bedrooms had sufficient lighting. LPA observed grab bars and non-skid surfaces in the bathrooms. LPA observed the applicant measuring the hot water temperature in the bathrooms. The water temperature measured between 105-110 degrees F. The facility had a sufficient amount of linen and hygiene items for the residents. In terms of the food supply, the facility had a sufficient amount of nonperishable and perishable food items. The food was kept in a safe and healthful manner. The facility menu was available for review. The freezer was 0 degrees F. The refrigerator was 45 degrees F. Dishes and glasses were in good condition. Trash cans have tight fitting covers. The facility had a designated area for staff and resident records. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. The facility was equipped with a complete first aid kit. There is adequate seating in the common areas. Facility had a supply of activities for the residents. LPA observed that the signal system located in the residents' room are functional. LPA also observed emergency lighting (e.g. flashlights). LIC continue 809-C No corrections are needed to be made. An exit interview was conducted and a copy of this report was provided to the applicant. Component III was read. Facility is ready for licensing.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 66 Interview Method: Telephone interview On 1/16/2026, applicant/administrator participated in COMP II. Identification of the administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’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, Jan 16, 2026

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 66 Census (if any clients in care): 42 Interview Method: Telephone interview On 12/2/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’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, Dec 2, 2025