Blossomkare

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unanounced to the facility at 10:00am to conduct an annual inspection, LPA met with administrator La Queta Gillbert. Licensed for 3 persons over age 60, wanting to do four, looking for approval from vmrc before moving forward with licensing. Physical Plant inspected, including bedrooms, bathrooms, exterior, common areas, evacuation routes. LPA gave guidance, the materess encasements will help with bed bug control. Water temp should be between 105-120. Smoke alarm is is functional, First aid kit has all required elements. kitchen has adequate storage 2 days perishable, and 7days nonperishable food, and lockable storage for sharps, toxics and medicaiton. fire extinguisher is dated 11/25/26. evacuation Gate needs a little wd-40. Administrator files are up to date and present. No surety bond, 308 needs a person when you hire somebody, the infection control plan, the evacuation control plan have all required elements. Required posters for emergency contact, facility sketch, admin cert are present in the facility. theft and loss policy, grievence policy, and refund policy, CPR/first aid. are up to date. Working with VMRC to get new clients, in contact prior to holiday. Client/Staff files, were not reviewed, there are no staff or clients in the facility. Licensee will send LPA control of property, via a grant deed/mortgage statement/lease agreement. Licensee will inform the LPA when a client gets into the building to come back and schedule a case management for reviewing the client/staff files. No citations issued, a copy of the report was read and given to the administrator. exit interview was conduct.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Required - 1 Year

On 1/18/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with Licensee, Laqueta Gilbert and explained the purpose of the visit. The purpose of this visit was to conduct an annual visit. Current census was 0. A brief interview with Licensee Gilbert was conducted. This facility is intended to hold 3 older adults of which all may be non-ambulatory with a hospice waiver for 2. The administrator has a current administrator certificate #6068206740 and expires on 12/25/2025. A tour of the facility was conducted. Smoke detectors and carbon monoxide detectors were observed to be in good compliance at this time. Fire extinguisher was serviced by a local fire company C.R. Fire Inc on 11/15/2024. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet, located in the kitchen area, was toured. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. Linen closet was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time with no hazards present. Garage area was toured. A washer and dryer was identified.. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610e No deficiencies were observed or cited during this annual visit. A copy of this report was given to Facility Designated Administrator. Exit interview.the state’s words, verbatim · CDSS document, Jan 18, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility on 1/24/24 at 10:15am and was met by the Applicant, Laqueta Gilbert. Brief interview was conducted with the Applicant. It was learned that this facility will be licensed as a residential care facility for the elderly (RCFE) to serve up to 3 non-ambulatory clients. There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. LPA observed no obstruction of emergency exits. Exit signs in place as appropriate. Fire extinguisher in place, located in kitchen, and fully charged. Facility map indicating emergency exits posted in appropriate locations. Complaint poster observed. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet, located in the kitchen area, was toured. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. Linen closet was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. This facility has been found to be in compliance at this time. There were no deficiencies observed during today's Pre-licensing visit. Component III completed with applicant during visit. Exit Interview conducted with Laqueta Gilbert A copy of this report was left with the Applicantthe state’s words, verbatim · CDSS document, Jan 24, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 3 COMP II Participant: LaQueta Gilbert, Managing Member/Administrator Interview Method: Telephone interview On 10/4/23, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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, Oct 4, 2023