Home of Bliss

Type of visit: Post Licensing

On 7-9-2026 at 3:25pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct a post licensing inspection visit. LPA met with the Administrator Shadae James and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an residential care facility for the elderly (RCFE) with a current census of 5. Facility has 5 bedrooms and 2 bathrooms for resident use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 1 ambulatory residents, 3 non ambulatory residents, 1 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 78*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 7-14-26. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts monthly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administratorthe state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Required - 1 Year

On 7-9-2026 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the Administrator Shadae James and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an residential care facility for the elderly (RCFE) with a current census of 5. Facility has 5 bedrooms and 2 bathrooms for resident use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 1 ambulatory resident, 3 non ambulatory residents, 1 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 78*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 7-14-25. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 5 resident files and 3 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training requirements. LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Prelicensing

On 7/07/2025, Licensing Program Analyst (LPA) Kesha Lewis arrived announced to conduct a Pre-Licensing visit. LPA was greeted by applicants, Licensee HOME OF BLISS LLC and administrator JAMES, SHADAE and explained the purpose of the visit. The purpose of this visit was to conduct a Pre-Licensing Visit. This facility will be licensed to hold 6 residents, of which 6 may be non-ambulatory in bedrooms and 2 hospice. A tour of the facility was conducted. Smoke detectors and carbon monoxide detectors were tested and are in good repair. A tour of the kitchen area was toured. A review of food supply was conducted to ensure a 2 day perishable and 7 day non-perishable food supply was available. This facility will have a locked medication cabinet located in the kitchen. A first aid kit was observed and had all the required components. Fire extinguisher was located in kitchen and was serviced on 07/08/2024 by the local fire company, Coast Fire Equipment Co. A tour of the family room was conducted. Furniture and furnishings were observed to be in good repair. A tour of the backyard was conducted with no hazards present. The perimeter gate was observed to be in good repair. A tour of the garage was conducted. A washer and dryer were identified. Detergent, toxins and other cleaning supplies were observed to be locked and made inaccessible. A tour of the resident bedrooms were conducted. Furniture and furnishing were observed to meet the residents’ needs. A linen closet was located in hallway and was observed to have a sufficient amount of linen to meet the resident’s needs at this time. A tour of two resident restrooms were toured. Hot water temperature was taken to ensure that it was within 105-120 degrees. Comp III completed.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Chukwudi Ikiseh CEO/ Shadae James Administrator Interview Method: Teams meeting On June 25, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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 the 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, Jun 25, 2025