Bluegarden Care

Type of visit: Required - 1 Year

On 4/30/2026 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver, Joana Dometita and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. Administrator, Yanlin Huang later arrived at 11:45AM. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher purchased 3/20/2026. Emergency Disaster Plan was reviewed on 4/30/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/01/2025. At 10:40AM, LPA reviewed 6 residents records. At 12:00AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. report continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed unlocked/unsecured chemicals/cleaners under the sink in the kitchen and residents room as well as unsecured knives in the kitchen in the drying rack. (Dawn multi surface cleaner, Meyer's clean day multi surface) LPA observed caregivers room door open/unlocked with unsecured prescription medications as well as medications in a small container that were in the residents room/ next to the resident and had not been taken LPA advised Administrator to purchase more nonperishable foods Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 5/12/2026: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 30, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 3/12/2024 at 8:40 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver, Joana Dometita and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. Administrator, Yanlin Huang later arrived. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher purchased 3/28/2025. Emergency Disaster Plan was last posted on 12/23/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/01/2025. At 9:00pm, LPA reviewed 5 residents records. At 10:00pm, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided. Administrator approved staff to signthe state’s words, verbatim · CDSS document, Mar 28, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: POC

On 03/22/2024 at 10:05am, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct proof of correction (POC) visit. LPA met with Carline Skang,Caregiver and explained the purpose of the visit. Administrator was notified of visit and approved caregiver to sign off on report. LPA A Gomez conducted an Annual visit on 03/12/2024 and cited facility for the following: 87412(a): During POC visit LPA reviewed the files for caregivers on shift. Staff (S1) file was observed to be incomplete and missing the LIC 508, LIC 501, and First Aid (Deficiency not clear) 87506(a): During POC visit LPA reviewed the files for residents and resident (R1) file was observed to be incomplete and missing signed and completed copies of the LIC 601, LIC 613C, LIC 627, and LIC 625 (Deficiency not clear) LPA spoke with administrator over the phone who stated that they need more time to obtain signatures for R1's records due to the family being unavailable. LPA also spoke to the administrator about S1 not having a complete file available at the facility for review to which the administrator requested more time. The LPA agreed to give the administrator a 2 week extension to clear the deficiencies and will return at a later date. The above POC's due date is now 4/5/2024 LPA observed that deficiency are not clear. No civil penalties assessed at this time Exit interview conducted and a copy of this report providedthe state’s words, verbatim · CDSS document, Mar 22, 2024

Type of visit: Required - 1 Year

On 3/12/2024 at 1:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver, Carline Skang and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. Administrator, Yanlin Huang later arrived. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 114.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide dectector were in operating condition during visit. Fire extinguisher available. Emergency Disaster Plan was last posted on 03/12/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/01/2023. At 1:30pm, LPA reviewed 5 residents records. At 4:00pm, LPA reviewed 1 staff records and 1 of 1 have current first aid training and associated to the facility. Report continues on LIC809-C The Following Deficiencies were observed during Inspection: At 2:00PM during file review LPA observed R5's file missing all documents except an admission agreement and physicians report 87506(a) repeat violation At 2:20PM during facility tour LPA observed an unlocked knife in Kitchen drawer by the sink. 87705(f)(1) repeat violation At 2:30PM during facility tour LPA observed an individual sleeping in room 7 who is listed as ineligible on guardian 87355(e) repeat violation At 3:20PM during file review Administrator does not have a valid Administrators certificate. 87406(a) At 3:50PM during file review S3 did not have a file or any of the required documentation 87412(f) repeat violation At 3:50PM during file review S3 did not have a TB test on file 87411(f) At 3:50PM during file review S3 did not have First Aid 87411(c)(1) repeat violation At 4:00PM During file review S2 did not have a complete file with the required document. They only has a health screening, LIC 501, and CPR/First Aid. Other staff files unavailable 87412(a) At 4:30PM during file review Quarterly Disaster drill was not done. After notifying Administrator LPA observed administrator inputting a date for December 2023. 1569.695(c) repeat violation A civil penalty is being assessed today for $3000 for repeat violation of 87355(e) {$100 a day x 30 days} A civil penalty is being assessed today for $1250 for all other repeat violations {$250 per violation x 5} Civil penalty total= $4250 Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/31/2024: LIC 500 Personnel Report Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided by email.the state’s words, verbatim · CDSS document, Mar 12, 2024

Type of visit: Case Management - Annual Continuation

On 10/31/2023 at 9:25 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced for an annual inspection continuation visit. Upon entry into the facility, LPA explained the purpose of the visit to Caregivers Carleen Sablan and Carline Skang. Licensee Yanlin "Cynthia" Huang arrived at approximately 10:00 AM. During the Inspection, the LPA reviewed facility records. 1 Type-A and 5 Type-B citations issued (for details refer to LIC809-D). Annual inspection incomplete. LPA will return unannounced at a future date and time. Exit interview conducted with Licensee. A copy of the Appeal Rights and this report provided to Licensee via email.the state’s words, verbatim · CDSS document, Oct 31, 2023

Type of visit: POC

On 10/31/2023 at 9:25 AM, Licensing Program Analyst (LPA) J. Sampair conducted a Plan of Correction (POC) inspection. Upon entry into the facility, LPA explained the purpose of the visit to Caregivers Carleen Sablan and Carline Skang. Licensee Yanlin "Cynthia" Huang arrived at approximately 10:00 AM. This visit was prompted by the citations from the 10/17/2023 annual inspection continuation visit. The Licensee had provided documentation of the correction of some of those citations. However, the Licensee had failed to provide documentation to the LPA that all of the citations had been corrected. During the visit, the LPA verified corrections of 11 out of 19 total citations. For those citations that had not been corrected, the Licensee incurred a total of $5,600 in fines. A civil penalty of $100 per violation per day shall be assessed until the violations are corrected. Exit interview conducted with Licensee. A copy of the Appeal Rights and this report provided to Licensee via email.the state’s words, verbatim · CDSS document, Oct 31, 2023

Allegation investigated: Facility did not provide a copy of resident's admission agreement to resident's authorized representative

On 10/30/2023 at 11:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with caregiver, Carleen Sablan and informed her the reason for visit. Administrator, Cynthia Huang arrived 45 minutes later. During the course of investigation, LPA interviewed 2 residents and 2 staff. LPA obtained and reviewed R1's admission agreement. Interview with staff revealed that a copy of the admission agreement was not given to resident/authorized representative because they did not request for a copy. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Exit interview conducted. A copy of this report and appeal rights provided. Substantiatedthe state’s words, verbatim · CDSS document, Oct 30, 2023 · control 15-AS-20231023113701

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(e) · Plan of correction due date: Nov 10, 2023

Admission Agreements. The licensee shall provide a copy of the signed ...admission agreement ...immediately upon signing the admission agreement... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not providing a copy of the admission agreement to resident which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2023

Plan of correction: Administrator has agreed to provide a copy of the admission agreement to resident and review regulation regarding admission agreement. Administrator will submit self-certification by POC date.

Type of visit: Case Management - Annual Continuation

On 10/17/2023 at 9:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct an annual inspection. Upon arrival, LPA explained the purpose of the visit to Caregivers Carleen Sablan and Carline Skang. Administrator (ADM) Yanlin "Cynthia" Huang arrived at approximately 10:15 AM. During the Inspection, the LPA inspected the facility inside and outside. LPA reviewed the records of 3 residents. LPA observed that the facility has a sufficient supply of food: 2 days perishable and 7 days nonperishable. A comfortable inside temperature of 70.4 degrees F was maintained. The facility was clean and the staff attentive to residents' needs. 2 Type-A and 17 Type-B citations issued (for details refer to LIC809-D). Annual inspection incomplete. LPA will return unannounced at a future date and time. Exit interview conducted with ADM and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Oct 17, 2023

Allegation investigated: Staff left residents in soiled diapers for an extended period of time causing residents to sustain sores. Staff does not feed residents in a timely manner. Staff does not bathe residents in a timely manner.

On 10/09/2023 at 10:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the initial 10-day complaint investigation of the allegations above. Upon entry, LPA informed Caregiver Evelia Galvan of the purpose of the visit, who informed Administrator (ADM) Yanlin "Cynthia" Huang. ADM arrived at approximately 11:15 AM. During the visit, LPA reviewed facility and resident records, and interviewed 1 resident, 1 staff member, and ADM. Staff left residents in soiled diapers for an extended period of time causing residents to sustain sores. Based on the records review, interviews with residents and staff, there was no data supporting this allegation. (Continued on LIC9099-C...) Unsubstantiated (...Continued from LIC9099) Staff does not feed residents in a timely manner. Based on the records review, interviews with residents and staff, there was no data supporting this allegation. Staff does not bathe residents in a timely manner. Based on the records review, interviews with residents and staff, there was no data supporting this allegation. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted with ADM. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Oct 9, 2023 · control 15-AS-20231002101429

Type of visit: Required - 1 Year

On 10/09/2023 at 10:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for complaint investigation and added the required annual inspection when complaint investigation completed. Upon entry, LPA informed Caregiver Evelia Galvan of the purpose of the visit, who informed Administrator (ADM) Yanlin "Cynthia" Huang. ADM arrived at approximately 11:15 AM. During the visit, LPA reviewed facility and resident records, and interviewed 1 resident, 1 staff member, and ADM. 1 Type-A citation issued during the inspection (details in LIC809-D) and Civil Penalty of $200 (details in LIC421-BG). Annual inspection incomplete. LPA will return unannounced to complete the inspection. Exit interview conducted with Licensee and a copy of this report was provided via email.the state’s words, verbatim · CDSS document, Oct 9, 2023