197610583-9-23-2024-31-AS-EMIR-DDFUSA-20250131145002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610583
Report Date: 09/23/2024
Date Signed: 09/23/2024 02:39:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/17/2024 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240917112355

FACILITY NAME:	BLOSSOM CARE FOR ELDERLY LLC		FACILITY NUMBER:	197610583
ADMINISTRATOR:	NERIA, ROMUEL		FACILITY TYPE:	740
ADDRESS:	1803 W AVE H1		TELEPHONE:	(661) 341-7594
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	6	CENSUS: 5	DATE:	09/23/2024
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Romuel Neria		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not address resident's medical condition-
Staff did not ensure resident's bedding was cleaned-
Staff did not keep facility free of insects-

INVESTIGATION FINDINGS:

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On Monday, 9/23/24, at 11:00am, Licensing Program Analyst (LPA), Raymond Comer, conducted an initial complaint inspection to investigate the above mentioned allegation(s). LPA Met with caregiver, Joseph Neria, who cooperated and assisted during the visit. The Administrator, Romuel Neria, was reached by cell phone, and the reason for the visit was disclosed. Later, around 12:30pm, the Administrator did arrive to the facility, met with the visiting LPA, and cooperated with LPA regarding the investigation.

Allegation: Staff did not address resident's medical condition-

Reporting Party (RP) alleges that Resident#1 (R1) developed skin blisters, and that Staff failed to seek medical attention in a timely manner. LPA conducted interviews, and reviewed documents. (i.e., medical records, medical assessments, and nurse’s notes)
[LIC 9099C]-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240917112355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BLOSSOM CARE FOR ELDERLY LLC	FACILITY NUMBER: 197610583
	VISIT DATE: 09/23/2024

NARRATIVE

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Information gathered by LPA reveals that facility Staff were indeed diligent in observing R1’s skin condition and did provide R1 access to medical attention in a timely manner. According to resident files, and interviews with Staff, R1 was recently admitted to this facility. Staff, along with attending family members, transported R1 to meet their Primary Care Physician. (PCP) A review of the doctor's notes indicate that R1's rash/blistering is a result of an autoimmune skin condition. The PCP prescribed medication to treat R1's skin condition. LPA interviews with Staff revealed that the prescribed medications are improving t R1's skin condition.

Based on LPA observation, interviews, and records review, this allegation is UNSUBSTANTIATED at this time.

Allegation: Staff did not ensure resident's bedding was cleaned-

Reporting Party (RP) alleges that facility is unsanitary, as Residents' sheets are dirty and are soiled. LPA conducted an facility observation, and interviewed Staff and Residents. LPA's inspection of facility, with particular focus of all resident rooms and bedding, reveals that resident linens, towels, and bedding, are cleaned and well maintained. Interviews with the Administrator, Staff, and Residents indicate there is no issues regarding the cleanliness of resident bedding, nor overall concerns regarding the cleanliness of the facility.

Based on LPA observation, and interviews, this allegation is UNSUBSTANTIATED at this time.

Allegation: Staff do not keep facility free of insects-

Reporting Party (RP) alleges that resident's sheets are dirty with ants, and/or other types of pests.
LPA conducted an facility observation, and interviewed Staff and Residents. LPA's inspection of facility, with particular focus of all resident rooms and bedding, reveals that facility is free of pests. Interviews with the Administrator, Staff, and Residents indicate there is no issues regarding the the presents of pests/vermin at the facility

Based on LPA observation, and interviews, this allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted and report was provided to the Administrator.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024

LIC9099 (FAS) - (06/04)

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