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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345003021
Report Date: 07/23/2025
Date Signed: 07/23/2025 12:56:07 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/02/2025 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20250602104434
FACILITY NAME:BLOSSOM RESIDENTIAL 1FACILITY NUMBER:
345003021
ADMINISTRATOR:TRIPADUSH, ALENAFACILITY TYPE:
740
ADDRESS:8934 VAN MOORE LANETELEPHONE:
(916) 578-9821
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 5DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator, Raluca SolovyevTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are not trained on how to operate a hoyer lift resulting in an injury to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 07/23/25 to deliver complaint findings for above allegations. LPA met with administrator Raluca Solovyev and explained the purpose of the visit.

The department conducted records review ,facility observations and interviews to investigate the complaint.



**Report continued on LIC9099-C**
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20250602104434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BLOSSOM RESIDENTIAL 1
FACILITY NUMBER: 345003021
VISIT DATE: 07/23/2025
NARRATIVE
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** Report continued from 9099.....

Allegation- Staff are not trained on how to operate a hoyer lift resulting in an injury to resident. Unfounded.

The Department conducted interviews with four (4) staff members, four (4) residents and reviewed record regarding the allegations cited above. Staff interviews revealed that staff have adequate training (on boarding and ongoing) regarding resident’s safe transfers techniques using a hoyer lift. Staff interviews also reflected that they felt comfortable regarding any residents who required 2 persons assist with transfers which requires hoyer lift. Four (4) residents interviews indicated that staff were properly trained, and residents felt safe with staff’s care. Record review indicated that facility has all required documentation regarding staff’s training's regarding Residents Transfers Techniques and other Care Provision per Requirement, therefore these allegations were found to be Unfounded.

A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

No citations were issued. Exit interview conducted. A copy of this report has been provided to facility.






SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2