Golden Bloom Villa

Type of visit: Required - 1 Year

On 6/29/26, Licensing Program Analyst (LPA) Kyle Wellington arrived unannounced to conduct an annual inspection. LPA was greeted and granted entry by Administrator (Admin), Liza Valencia, who was informed of the purpose of the visit. LPA observed two (2) staff and six (6) residents present at the facility. Census at the facility is six (6) residents. LPA received a staff and resident roster from Admin. LPA toured the facility with Admin. LPA conducted an observation and record review for the inspection. Facility Overview: The facility is a one story house with six (6) resident bedrooms, two (2) resident bathrooms, kitchen, dining room, living room, laundry room, one (1) caregiver bedroom and one (1) caregiver bathroom. There are no pools, bodies of water or firearms at the facility. The facility has a fire clearance to serve five (5) non-ambulatory residents and one (1) bedridden resident for a total of six (6) residents. The facility has an hospice waiver for six (6). Infection Control: LPA observed soap dispensers and hand sanitizers throughout the facility. Cleaning equipment and supplies were was kept in the locked laundry room and available for regular facility maintenance. LPA reviewed the facility’s infection control plan which met the department’s requirements. Physical Plant: LPA observed the inside and outside of the facility to be clean, safe and well kept. The floors, windows and doors were clean and well maintained. The living room and dining room furniture was in good repair. The bedrooms and halls had night lights and the halls were free of obstruction. The residents’ bedrooms were neat, organized and contained the required bedding, lighting and furniture. Bathrooms were clean, tidy and had grab bars, paper towels, soap and non-slip mats in the showers. Extra linen and towels were kept in a cabinet in the hall. Laundry equipment appeared to be in good working condition. Laundry supplies were kept in the locked laundry room.. The seven (7) fire extinguishers were charged. LPA tested one (1) of the smoke and carbon monoxide detector and found it to be operational. The backyard was free of hazards and contained outdoor furniture and shaded area for the residents. Kitchen/Food Service: LPA observed the kitchen to be clean, organized, and well maintained. The kitchen had the ability to prepare and store food in a safe and clean environment. Kitchen appliances appeared to be in good working condition. All sharp objects were kept in a locked cabinet in the kitchen inaccessible to residents. Cleaning supplies were kept in the locked laundry room inaccessible to residents. Facility has over a two day supply of perishable foods and over a seven day supply of non-perishable foods available. Care & Supervision: Facility had sufficient staff to supervise the residents. Staff had criminal record clearance and was associated with the facility. Administration: LPA observed personal rights, emergency/disaster plan, emergency phone numbers, complaint procedures and ombudsman information posted near the front door at the facility. Admin holds a current Administrator Certificate and a Criminal Record Clearance. Record Review and Resident/Staff Files: LPA reviewed the records of two (2) staff files and three (3) resident files. The files contained all the required documentation and paperwork. The staff and client files were kept in a locked cabinet in the dining room inaccessible to unauthorized individuals. Health Related Services/Incidental Medical Services: LPA observed first aid kit and clients' medications were centrally stored in a locked cabinet in the dining room inaccessible to unauthorized individuals. First aid kit contained all the required items. LPA reviewed three (3) residents' medication to the facility’s medication log to make sure all medication was accounted for and dispensed correctly. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. It is current and up to date. Facility's fire and emergency drills are conducted quarterly. Facility's property and liability insurance expires on 6/22/27. All facility exits were clear of obstructions. No deficiencies were cited during this visit. Exit interview was conducted with the Administrator, Liza Valencia, and a copy of this report was given to the Administrator, Liza Valencia.the state’s words, verbatim · CDSS document, Jun 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility unannounced to conduct an annual inspection. LPA was greeted by Liza Valencia, Administrator and the purpose of the visit was explained. Present at the facility were one (1) staff member and five (5) clients. LPA conducted staff interviews, however all clients declined to be interviewed due their mental and physical conditions. The facility is a one story seven (7) bedroom, three (3) bathroom home. All bedrooms are private. The home is approved for five (5) non-ambulatory clients and one (1) bedridden client for a total of six (6) clients. A tour of the facility was conducted inside and out. The smoke alarm system was tested and found operable. Hot water temperature was tested at 110 degrees Fahrenheit. Food was stored in a safe and healthful manner. The facility had a 2 day supply of perishable food items and 7 day supply of nonperishable food items. LPA reviewed staff and client records. Review of staff records indicate all staff have criminal record clearances and are appropriately associated to the facility. Staff files had the required documentation including First Aid Certifications and training documents that included recent training. Review of the facility training binder showed the following refresher training completed include: Alzheimer's, Emergency Disaster, Postural Supports, Restricted Conditions, Hospice, Reporting Abuse, Food Handling, Dementia, Fall Prevention and Medication training. Review of client files revealed all client records are current and up to date. LPA inspected medications and medications appear to be dispensed appropriately according to physician's orders. The outdoor space is free of hazard and has shaded areas with plenty of seating. Emergency drills are conducted quarterly. Fire extinguishers are fully charged. No weapons, guns or ammunition are stored at the facility. During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided to Liza Valencia, Administrator.the state’s words, verbatim · CDSS document, Jun 25, 2024

Type of visit: Case Management - Other

On March 22, 2024, Licensing Program Analysts (LPA), Venus Mixson conducted an unannounced visit to the facility for purpose of conducting an updated Fire Clearance inspection, and met with Licensee Liza Valencia, introduced herself and stated the purpose of the visit. The Facility File review was conducted at the Regional Office and additional forms were requested and reviewed on site. An initial application to operate an Adult Residential Facility (ARF) was received by the Central Applications Bureau (CAB) on 11/15/2021 for a total capacity of six non-ambulatory and one bedridden resident. The previous Fire Clearance was approved on 03/01/2022, for six non-ambulatory and one bedridden resident. The new Fire Clearance was approved on 03/04/2024, for five non-ambulatory and one bedridden resident, but still for a total of six. Following is a summary of LPA’s observations. Structure: The Facility is a single-story home located at 725 Golden Bloom Lane, Fallbrook, CA. 92028, and has six resident bedrooms, and three full bathrooms, family room, dining area and kitchen. Heating/Cooling System: Central heating, and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Each bedroom had the required furnishings as required by regulations to include bed, chair, adequate lighting, and an operable smoke alarm/carbon monoxide detector. Required furnishings were observed presently. Bathrooms: The bathrooms had working toilets, wash basins, and showers. The Administrator informed the LPA the water is tested and logged monthly or as needed, in the residents' bathrooms. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Cleaning supplies were secured in a locked cabinet below the sink. Knives/sharp instruments were stored in a locked cabinet. There is adequate room for food storage. LPA Mixson observed the stove to be operational. Refrigerator/freezer were in working condition, CONTINUED. CONTINUED and had enough storage for perishable food. There was adequate seating for meals for residents currently at the time of this review. The laundry area with washer and dryer were in a separate room and were clean and free of odors. Living/Family room: The family room was safe and had adequate seating for residents in care and was neat organized and free of clutter and odors at this time. Linens and Hygiene Supplies: An adequate supply of linens were stored in the hallway cabinet and a sufficient supply of hygiene and other personal items were seen presently. Yards/Outside: The entire backyard was secured with a fence, and the outdoor pathways were free of obstructions. There were no bodies of water observed anywhere on the property at this time. and the patio furniture was observed to be assembled and available as needed with a patio covering. Garage: There was no garage reviewed or observed currently at today’s facility inspection. Emergency Phone Numbers, and Exit Plan: The required emergency phone numbers, and facility sketch were observed. General items: Three fire extinguishers were observed and were charged and mounted in kitchen and one was near the front door, the last one was observed in the laundry room. Smoke alarms and carbon monoxide detectors were mounted and had a visible green light and were operable. LPA Mixson observed the required postings posted in a prominent area for review. The new Fire Clearance: The West wing is now approved as per the new Fire Clearance to meet fire department requirements for future use. Based on today’s health and safety review there were no health and/or safety issues observed or cited per Title 22, Division 6, Regulations. An exit interview was conducted, and a copy of this report was provided to Liza Valencia, the Administrator.the state’s words, verbatim · CDSS document, Mar 22, 2024