Blossom Valley Residential Care

Type of visit: POC

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to complete a Change of non-ambulatory status application, which was submitted on June 27, 2026. LPA introduced herself, explained the purpose of the visit and was allowed entry into the facility by Brandy Patton, Administrative Assistant. Adriana Myers, Administrative Assistant, arrived shortly after and conducted the tour with the LPA. The Licensee requested approval to have four (4) non-ambulatory residents live in the facility in two (2) non-ambulatory bedrooms. The facility was initially approved for (2) non-ambulatory residents in one (1) non-ambultatory bedroom. The fire department inspection was completed on July 27, 2026 and bedroom #2, which was previously used for ambulatory residents, has been cleared to be used as a non-ambulatory bedroom. The Licensee installed an exit door in the bedroom and ramp leading to the patio. LPA toured the facility and confirmed that currently, there are three (3) non-ambulatory residents living in both of the non-ambulatory bedrooms, which are bedrooms #2 and #3. This Change of non-abulatory status application is complete. The information has been sent to the CCLD management team to update the current license. No new deficiencies were identified or cited during today's visit. An exit interview was conducted with Adriana. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided and signature below confirms receipt of the documents.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to conduct a required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves and discussed the purpose of the visit with Administrator Trish Pena. LPA began the annual inspection with Trish and completed the inspection with Care Staff Leandra Smith. During today’s inspection, there were a total of 4 residents in care. According to the facility's license, the facility is approved for six residents, age 60 and over. Rooms #1 and #2 are for ambulatory residents and Room #3 can have two non-ambulatory residents. Hospice is approved for two (2).This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by Leandra, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 71 degrees F. Hot water temperature at taps accessible to residents were compliant. No pools or bodies of water were observed on the premises. Per Leandra Smith, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. (CONTINUED ON NEXT PAGE, LIC 809C) (CONTINUED FROM PAGE 1, LIC 809) First aid kit(s) were complete and readily accessible. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Required licensing postings were observed in visible areas of the facility. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored in the kitchen. Cooking/dining equipment and utensils were present. There are activities for the residents to participate in. LPA interviewed staff and residents. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. Confidential records were stored in locked areas. The facility is approved for two (2) non-ambulatory residents in bedroom #3. Based on a review of resident medical evaluations, there are currently three (3) non-ambulatory residents living in the home. An immediate civil penalty in the amount of $500 is being assessed on an LIC 421IM for a fire clearance violation in accordance with Section 1568.0822 (2)(A) of the Health and Safety Code. An exit interview was conducted with Leandra, and copies of this report, LIC 421IM, and Licensee/Appeal Rights (LIC 9058 03/22) were provided via email. The signature below serves as acknowledgment of receipt of the documents. .the state’s words, verbatim · CDSS document, Jun 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(b) · Plan of correction due date: Jun 27, 2026

(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. This requirement is not met as evidenced by: Based on a review or resident medical assessments, the licensee did not comply with the section cited above in 1 out of 4 clients, which poses an immediate health risk to persons in care.the state’s words, verbatim · CDSS document, Jun 26, 2026

Plan of correction: Licensees will submit an LIC 200 Application for a fire clearance within 24 hours to change their clearance from 2 non-ambulatory to 4 non-ambulatory. If Licensee is not approved for the fire clearance, Licensee will serve the client with an eviction notice.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced post licensing visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Trish Pena. The facility is licensed for 6 residents, 4 of whom may be ambulatory and 2 may be non-ambulatory. The facility has a hospice waiver for 2 residents. LPA and Administrator toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order and bathroom sinks were compliant temperatures. The facility’s ambient internal temperature was comfortable and complaint. The facility has enough linens, hygiene supplies, cooking and dining supplies. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. All kitchen appliances were in working order. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. LPA reviewed facility records and the files reviewed contained required documents. (CONTINUED ON LIC 809-C, NEXT PAGE) (CONTINUED FROM LIC 809) No pools or bodies of water on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per Administrator, no firearms or ammunition are at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. No deficiencies were observed or cited during today's visit. An exit interview was conducted with Trish Pena, Administrator, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Nov 24, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Iby Strong, conducted an announced Pre-Licensing inspection. LPA met with Licensee Danielle Stanton, Administrator Patricia Pena and House Manager Pamela Hernandez and discussed the purpose of the visit. LPA conducted a tour of the facility, both inside and outside. There are no bodies of water present. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, blinds and paint throughout the facility, were observed in good condition. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. Licensee stated there are no firearms stored on the premises. Hot water temperature was measured in the facility at 118 degrees F. The ambient temperature inside the facility was measured at 70 degrees F. The facility was observed to be clean and kempt. The refrigerators and freezers were observed to be clean and operational, with an ample amount of food to meet resident needs. Cleaning solutions were also properly secured in the storage rooms. LPA Strong observed locked cabinets intended for future medication use. The Component III portion of the application process was completed with Licensee Danielle Stanton, Administrator Patricia Pena and House Manager Pamela Hernandez on today's date as well. Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted. The Applicant will be provided a copy of their Appeal/Licensee rights (LIC9058 01/16) and this report on todays date.the state’s words, verbatim · CDSS document, Jun 13, 2025