Grace Blossom Care

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) De Christian Gutierrez conducted a case management visit at the facility to check on the health and safety of the Residents in care. LPA met with the Caregiver Julie Hunter who assisted with the visit. Administrator Lilian Okereke was contacted via text and stated she was currently in a meeting. During the visit, LPA conducted a health and safety check of the six (6) residents which include tour the facility. LPA did not observe any health and safety concerns or issues with residents in care based on Title 22 regulation. No deficiencies were observed during today's visit. Exit interview was held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Office

An informal office meeting was held at the Monterey Park Adult and Senior Care Licensing Office. Regional Manager Tony Vasallo, Licensing Program Manager David Sicairos and Licensing Program Analyst Noemi Galarza met with Mego Inc, Licensee/Administrator Lilian Okereke and caregiver Julie Hunter. The purpose of the meeting was to discuss control of property issues and the recent annual inspection visit conducted on March 26, 2026. The meeting addressed property lease changes, citations issued during the last inspection, record keeping, and physical plant issues. Discussion: Control of property regarding property lease changes. The lease expired in December 31, 2025. A renewal lease contract is pending negotiation. The initial lease renewal proposal was a month to month lease, and as of April 2, 2026 the proposed lease agreement states it will be for 1 year. Contingency Plan for a change of location if applicable was discussed. A potential property has been identified. Licensee was provided Centralized Application Bureau contact information. Resident (R1's) pending Physician's Report. Licensee stated that family has not obtained/provided a copy. Physical plant issues- Licensee stated that landlord issues began last year when licensee requested A/C repairs. Ms. Okereke stated that the landlord has been providing inconsistent information to licensee and CCLD. Licensee agreed to update the Department on the property lease agreement by April 30, 2026. Exit interview was conducted and a copy of this report was provided to Licensee Lilian Okereke.the state’s words, verbatim · CDSS document, Apr 15, 2026

Type of visit: Required - 1 Year

License Program Analysts (LPA) Christian Gutierrez conducted an unannounced annual required visit. LPA met with Administrator Lilian Okereke and explained the reason for today’s visit. The Facility is licensed to serve six (6) non-ambulatory residents aged 60 and above of which 1 may be bedridden. Facility has a hospice waiver for 4 residents. There is one resident with hospice services at the moment A tour of the single-story facility included: living room, kitchen, dining area, activity area, 4 resident bedrooms, 1 administrator office, 1 staff bathroom, 1 resident bathroom, and attached garage. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. Smoke detector were observed in each bedroom. Bedroom number one was missing a screen on window, and bedroom number three had a hole in wall. Two residents who receive oxygen did not have the required sign on door. Carbon monoxide detectors were observed in facility. The facility has two (2) fully charged fire extinguishers. Cleaning supplies and toxic substances are inaccessible locked under kitchen sink. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. LPA observed a broken drawer being held together by black tape in kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grab bars and non-skid mats. The hot water temperature in the bathrooms were not measured between the required range of 105-120 degrees F. The common areas, including the living room and dining area, are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. LPA observed a large bag of fertilizer backyard accessible to residents. SEE LIC 809C Three (3) out of four (4) staff files reviewed included criminal clearance record, health screening with TB. S1 and S2 were both missing required annual training and both had expired CPR cards. S3 did not have a health screening with TB or a CPR card. Three (3) out of five (5) resident files reviewed and did not have updated physicians’ reports. Fire/earthquake drill was conducted in January of 2026. Infectious control plan was reviewed. A copy of emergency disaster plan was provided to LPA. Three (3) resident medications were reviewed. Medications are centrally stored and locked MAR log is used. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview was held and a copy of the report along with appeal rights were given to Administrator.the state’s words, verbatim · CDSS document, Mar 26, 2026

Type of visit: Required - 1 Year

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPAs met with Esther Araiza. Ms. Araiza called Administrator to inform of LPA visit. Administrator was not available at the time but requested Julie Hunter to help during visit. The purpose of today’s visit was explained to facility personnel met during this visit. Administrator Facility is licensed to serve six (6) non-ambulatory residents aged 60 and above of which 1 may be bedridden. Facility has a hospice waiver for 4 residents. Administrator. Administrator arrived and participated in visit. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT · Three (4) resident bedrooms, two (2) Full Bathroom, attached car garage, shaded outdoor area, living room, kitchen, and dining room, and front and back yard. REVIEW OF FILES · Resident Admission Agreements, Residents & Staff files, Staff fingerprint clearance, Medications, Staff First Aid Certificate, Consumer Needs and Service Plan. · LPA reviewed three (5) staff files and four (5) Resident files. Interview was conducted with two (2) staff and one (1) Resident. Other residents were sleeping or unable to respond to questions. Continue on page 809C. Observations during facility tour: · Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPAs observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for residents. · Wall and floors are in good repair. Hallways were clean and free of obstructions. · Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. · Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. · Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. · The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. · Sharps are locked in kitchen and inaccessible to residents. Also, disinfectants and cleaning supplies are locked and secured inaccessible to residents. · Smoke detectors were observed in all bedrooms and carbon monoxide detectors was observed in living room around kitchen area. One (2) fire extinguishers were observed and were fully charged with last inspection on 7/23/24. · Last fire drill and disaster drill was conducted on 1/17/25. · Front and back yards are free of hazards and there were no bodies of water present at facility. Shaded area was available to residents. · The medications are centrally stored and locked in a cabinet in kitchen. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all six (5) residents. Resident 1 (R1) had PRN prescription (Furosemide 20 mg) was given to resident but there was no documentation. In addition, two medications (Docusate Sodium 250 mg and Ferrous Sulfate 325 mg) had not been refilled. Resident 2 (R2) did not have medication on refilled (Memantine HCL 10mg, Vitamin D3 50 mg, Donepezil 5m). Resident 3 (R3) did not received medication as prescribed (Melatonin 5 mg). Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Julie Hunter Caregiver and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents aged 60 and above of which 1 may be bedridden. Facility has a hospice waiver for 4 residents. The facility is operating within the scope of its license. A tour of the single-story facility included: living room, kitchen, dining area, activity area, 4 resident bedrooms, 1 administrator office, 1 staff bathroom, 1 resident bathroom, and attached garage. LPA toured the facility and observed the following: Each client bedroom has the required furniture and bedding. There is extra clean linen and towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is 1 carbon monoxide in the hallway and is properly operating. Knives, cleaning solutions, and disinfectants are locked inside a cabinet located in the garage. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 45 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. (Continued on LIC 809C) Staff and client files were not accessible during todays visit see 809D.No fire/earthquake drill was available. No Disaster Plan was available on today’s visit. Infection control plan was reviewed. The medications are centrally stored and locked in a cabinet in kitchen. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all six (6) residents. Resident 1 (R1) was missing one medication Donepezil 5 MG once daily. No tweezers were available in first aid kit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, May 7, 2024

Allegation investigated: Staff did not prevent a resident from falling, resulting in resident becoming wheel chair bound.

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Jamore Splung (Caregiver) and explained the reason for the visit. The investigation consisted of the following: LPA Mora reviewed Resident 1 (R1) entire file, and interviewed Administrator, Staff 1 - Staff 2 (S1 - S2), Resident 1 - Resident 6 (R1 - R6), R1's Responsible Representative 1, and R1's Responsible Representative 2. The investigation revealed the following: regarding the allegation "staff did not prevent a resident from falling, resulting in resident becoming wheel chair bound.", it is alleged that staff are not properly taking care of R1 which led to a fall and caused R1 to be wheelchair bound. (Continued to LIC 9099-C) Unsubstantiated Administrator and staff interviewed denied the allegation and stated that R1 has not had a fall at this facility. Administrator stated that in December 2021 R1 was hospitalized due to GI issues and had surgery, and returned to the facility in January 2022 with a wheelchair. Home health provided physical therapy for a couple of weeks, but the resident remained wheelchair bound. LPA attempted to interview R1, but R1 stated does not remember having a fall and only commented about having knee surgeries. R1 was unable to provide any other details regarding the surgeries or the reason why R1 is wheelchair bound. Review of R1's file revealed the following: R1 was admitted to this facility on 09/15/2021. Physician report dated 09/08/2021 states that R1 is ambulatory and may use walker or wheelchair. Preplacement Appraisal dated 09/14/21 states that R1 had left knee surgery on 08/30/2021 and walks with a walker. The Appraisal/Needs and Service Plan dated 09/15/2021 also state that R1 walks with a walker. Incident report dated 12/10/2021 states that R1 was sent to the hospital on 12/09/2021 due to black vomit and stool. Incident report dated 12/22/2021 states that R1 returned back to the facility on 12/15/2021 with lots of pain on the left knee and ended being sent again to the hospital on 12/18/2021 for black vomit and stool again. Incident report dated 01/07/2022 states that R1 returned to the facility after being hospitalized from 12/18/2021 to 01/07/2022 and had a surgical intervention over the course of GI bleeding. The Appraisal/Needs and Service Plan dated 09/15/2022 states that R1 is wheelchair bound. There are no records or incident reports stating that R1 had a fall. R1's Responsible Representative 1 confirmed that R1 returned to the facility from the hospital on a wheelchair in January 2022 after having gallbladder surgery and since then has been on a wheelchair. There is no records or evidence to support that the resident is wheelchair bound due to a fall. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview held and a copy of the report was providedthe state’s words, verbatim · CDSS document, Jan 25, 2024 · control 28-AS-20240116103521