Blossom Home Care

Type of visit: Required - 1 Year

On 2/4/2026, Licensing Program Analyst (LPA) Imaculada Vasquez, Valerie Flores, and Aziz Faizi conducted an unannounced 1-year required visit. LPA's were greeted and granted entry into the facility by care staff Natalie Sumolang. LPA's conducted a tour of the facility alongside Natalie. During the visit, LPA's observed the following: The physical plant is a single-story structure which consisted of (4) four resident bedrooms, (2) two bathrooms, living room, dining area, laundry room, garage and backyard. Resident bedrooms were equipped with the required bedding, furniture, and functional lighting. Bathroom were observed; toilets and shower areas were observed to be equipped with the required grabs. Showers also maintained slip-resistant materials. LPA's observed games and other activities located in the living room. Indoor and outdoor passageways were observed to be free of obstruction. The facility operates laundry services on-site. Soaps and other disinfectants were observed to be stored in a locked cabinet. The kitchen was observed to be organized and sanitary. LPA's observed a locked cabinet which stored knives and other sharp materials. The facility maintained a (2) two-day supply of perishable foods and a (7) seven-day supply of non-perishable foods. An activity calendar was observed to be posted and current. Emergency food and water were observed to be stored in the garage. Backyard was observed to have a covered patio that was furnished. LPA's observed the required postings of the PUB475, LTCO, license, facility sketch, personal rights, and current Administrator Certification. (2) Two staff files were reviewed. Staff review included but not limited to personnel records, health screenings, TB results, and relevant training's. (3) Three out of (4) four resident files were review. Records reviewed included but not limited to admission agreements, preplacement appraisals, appraisals, medical assessment, and current medication list. An exit interview was conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Feb 4, 2026

Type of visit: Prelicensing

On February 12, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a Pre-Licensing visit. LPA Mixson met with the Administrator, Gianna M Ibach, introduced herself, and stated the purpose of the visit. Physical Plant: The location is a single-story home located at 28492 Pear Blossom Lane Moreno Valley, CA. 92555. and has four bedrooms, two full bathrooms, a living room, dining room, and a kitchen, with a two-car garage. A backyard and front yard. The Moreno Valley Fire Department approved this facility for five non-Ambulatory, zero-Ambulatory, and one bedridden residents, on January 07, 2025. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and the Administrator’s certificate is current. (87303). Medications: LPA Mixson observed where medications are to be stored, locked, and inaccessible to the residents. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed and are operable. LPA Mixson observed the fire extinguisher, it was charged and in the green, and obtained on 11/01/2024. The cleaning supplies were locked and inaccessible, along with the sharp objects and the Administrator informed the LPA there are no firearms on the premises. (87465). Bedrooms: The bedrooms were large enough to allow for easy passage between the beds, and other required items of furniture were present currently at the time of this inspection. Chair, nightstand, and sufficient lighting for future residents. (87307). Kitchen/Food: The knives were locked in a kitchen drawer, plenty of pots, pans, and other kitchen accessories. The facility has the required seven-day supply of non-perishable food items and the two-day supply of perishable food items. LPA Mixson observed hygiene supplies for residents. There were no pesticides, poisons, or other toxic substances stored in any food storage or preparation area currently at the time of this inspection. Trash bins have tight fitting covers and plastic lining. (87303) & (87555). Records: There is confidential storage space for personnel records at the time of this visit. (87412). Bathrooms: The bathrooms floors were clean and sanitary and free of odors, water and other appliances were operable, water temperature tested within regulations. There was at least one toilet and sink for each six persons to include residents, family, and personnel. (87307), and at least one bathtub/shower for each ten persons which includes residents, family and/or live-in personnel. (87307). Administration: LPA Mixson observed emergency exiting plans and telephone numbers posted, Personal Rights, Complaint Poster, and other required documents were posted currently at the time of this visit, along with the current Administrators certification. The facility theft and loss program policy are posted, currently at the time of this inspection. (87218). Activities: There are activity supplies and equipment, including access to daily newspapers, current magazines, and a variety of reading materials in the language of choice. There is an outdoor activity area equipped for outdoor use. (87219). Miscellaneous: There is a first aid kit, including sterile dressings, bandages, thermometer, and other items as required by regulations. (87465). There are laundry supplies and equipment, including machine in good repair, and there is space for clean linen storage and a separate space for soiled linen. (87307). LPA Mixson observed emergency lighting supplies to include flashlights, and extra batteries, along with vehicles used to transport residents are operable and registered as stated by the Administrator. (87303). Dementia Care: There were no bodies of water on the premises currently at the time of this visit, and there are auditory devices in place to monitor exits and completely enclosed outdoor activity space with self-closing latches and gates. (87705). Inside/Outside: All doors, and passageways are clear of obstruction. There were no bodies of water on the premises, and the fireplace was covered with a screen. There was enough clean linen and hygiene items, and there was appropriate lighting in each room. LPA Mixson observed central heating and air conditioning systems, and they are operable. Supplies: There is a sufficient supply of clean linen, including blankets, bedspreads top sheets, bottom sheets, pillow cases, mattress pads, bath towels, hand towels, and wash cloths, to permit changing weekly or more often as needed. (87307). The Administrator dialed the land line phone number (951) 208-0353, and it was operable. Outside/Yards: Had shade and covering for shaded visits, and activities. There were no obstructions observed. The Licensee stated there were no firearms, and/or ammunition on the premises. CAB 8.0 Pre-licensing / COMP III Completed 02/11/2025. An exit interview was conducted, a copy of this report was provided to the Administrator, Gianna M Ibach.the state’s words, verbatim · CDSS document, Feb 12, 2025