Blueberry Hill Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced and met with Licensee Keith Hamric to conduct an annual inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed resident rooms, common area bathrooms, kitchen, common areas and perimeter of care home. LPA observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 108.8 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are operational in the care home. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed four (4) resident files, staff files and resident medications. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of this visit, no deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted with Administrator.the state’s words, verbatim · CDSS document, May 20, 2026

Allegation investigated: Staff left residents in a soiled diaper for a long period of time. Staff did not properly clean a resident in care. Staff does not ensure that a resident in care is fed. Staff did not prevent a resident from developing a pressure injury while in care. Facility is allowing unqualified staff to fill a syringe with medication. Staff are smoking inside of the facility.

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Carestaff Latonia Swain to deliver findings for the above complaint allegation.LPA spoke with Administrator Keith Hamric via phone to discuss findings During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: *** Report continued on 9099-C*** Unfounded Staff left residents in a soiled diaper for a long period of time. Interviews with residents indicated they feel their incontinence needs are being met by care staff. Interviews with staff indicated that two residents are continent and able to use the restroom with minimal assistance. One resident is incontinent but vocal regarding need to be changed. Interview with Resident R1 indicated that they have no issues with getting assistance with changing after using the restroom. Therefore the allegation staff left residents in a soiled diaper for a long period of time is unfounded. Staff did not properly clean a resident in care. Records reviewed indicated that residents in care were receiving proper care and cleaning which was logged on a daily basis. Records indicated that residents were receiving three or four showers per week unless it was declined by resident. Observations indicated that residents were clean and did not present any odors. Interviews with residents indicated that they feel their hygiene needs are being met by staff. Therefore the allegation staff did not properly clean a resident in care is unfounded. Staff does not ensure that a resident in care is fed. Interviews conducted with Resident R1, R2 and R3 indicated that they are content with the meals being provided at the facility. Interviews with staff indicated that they will assist residents as needed with meals and offer additional options if the food made at that time was not desired or liked. Observations indicated that there is a variety of food at the facility for resident consumption. Therefore the allegation staff does not ensure that a resident in care is fed is unfounded. Staff did not prevent a resident from developing a pressure injury while in care. Interviews with Resident R1 indicated that they stay in bed most of the day but are able to turn themselves and reposition as needed. Interviews with staff and administrator indicated that R1 uses a hoyer lift for transfers out of bed and is able to reposition themselves as needed. Staff assist with changing R1 and have not seen any signs of skin breakdown. Therefore the allegation staff did not prevent a resident from developing a pressure injury while in care is unfounded. ***Report continued on 9099-C2 page Facility is allowing unqualified staff to fill a syringe with medication. Records reviewed indicated that syringes were being filled by outside agency for resident who was on hospice care. Facility documentation indicates when syringes were being filled and given to resident. Interviews conducted with staff and administrator indicated that hospice agency filled all medications for resident. No staff at the facility were in charge of drawing up medications for residents. Therefore the allegation facility is allowing unqualified staff to fill a syringe with medications is unfounded. Staff are smoking inside of the facility. Interviews with staff, administrator and residents all indicated that no individuals smoke within the facility. Observations indicated that there was an ash tray on the back patio of the facility which contained cigarettes. Observations also indicated that there was no odor of smoke within the facility and no physical indications of smoking were seen within the facility. Therefore the allegation staff are smoking inside of the facility is unfounded. Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Aug 28, 2025 · control 59-AS-20250717100855

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced and met with Administrator Keith Hamric to conduct an annual inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed four (4) resident rooms and two (2) common area bathrooms. LPA observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 109.7 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are operational in the care home. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed four (4) resident files, three (3) staff files and resident medications. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of this visit, no deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted with Administrator.the state’s words, verbatim · CDSS document, Mar 13, 2025

Type of visit: Required - 1 Year

On 5/22/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the full CARE tool. LPA met with Caregiver who then contacted Administrator who then arrived to the facility shortly. LPA observed the presence of five residents in care, two residents were in their private rooms and three residents in the common area, watching television. During today's inspection, LPA and Administrator conducted a tour of the interior of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to: four residents room, bathroom, garage, kitchen, and the common areas. LPA observed the sharps to be locked and secured in the kitchen. LPA observed the facility to have 2+ days of perishables and 7+ days of nonperishable foods. LPA observed facility to have ample supply of linens for residents in care. LPA observed facility to be clean, sanitary and in good repair. LPA and Administrator discussed the definition of non-ambulatory as Title 22 defines non-ambulatory as a "persons who are unable, or likely to be unable, to respond physically or mentally to an oral instruction relating to fire danger". LPA discussed with Administrator that Bedroom 1 may be non-ambulatory if a direct exit door is installed. File review conducted five residents and four personnel files. LPA completed the care tool and found facility to be in compliance to California Code of Regulations, Title 22. No deficiencies cited. Exit interview and a copy of report was provided.the state’s words, verbatim · CDSS document, May 22, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual inspection. LPA met with Caregiver who then contacted Administrator who then arrived to the facility shortly. LPA is conducting an annual inspection today but this report is being generated to clear the Post-Licensing inspection in the system. There are no citations issued on this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, May 22, 2024