BLOSSOM GARDEN SENIOR HOME

21307 WESTERN BLVD, Hayward CA 94541

Facility 015601482 · RESIDENTIAL CARE ELDERLY (740)

9 bedsLatest official report Dec 10, 2025Licensed

Additional info
Licensee
BLOSSOM GARDEN SENIOR HOME, LLC
Administrator
HYESUS, FEKERTE
Contact
HYESUS, FEKERTE
License first date
Dec 6, 2012
License effective date
Dec 6, 2012
District office
OAKLAND ASC · (510) 286-4201
Regional office
15
Clients served
935 - ELDERLY

Summary

The available records show 3 Type A and 5 Type B deficiencies for this facility.

Most recent inspection
Dec 10, 2025
Most recent deficiency
Dec 10, 2025

No later report is available, so the records do not show what happened afterward.

What Type A and Type B mean
Type A
Violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
Type B
Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.

Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.

At a glance

Counts cover the five-year public record. Typical figures are the median for the 18 Alameda County facilities licensed for 7 to 15 beds, except where too few exist to state one — those come from facilities with 7 or more beds.

In the available public five-year record, CCLD published 6 reports for this facility: 5 inspections, 1 complaint investigation, and 0 licensing or administrative records.

Those records contain 3 Type A and 5 Type B deficiencies.

0 deficiencies have explicit official correction or clearance evidence in the loaded records.

Official inspections
5

Fewer than the typical 8

1 in the last 12 months

Recorded deficiencies
8

More than the typical 7

4 in the last 12 months

Type A deficiencies
3

More than the typical 2

2 in the last 12 months

Type B deficiencies
5

About the same as most this size

2 in the last 12 months

Substantiated complaints
0

Fewer than the typical 1

0 in the last 12 months

Repeated topics
0

Last 36 months

Repeated topics

Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.

No topic repeats in the last 36 months

No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.

Official report history

All preserved reports from the most recent to the oldest, sortable by report type.

Inspection
Facility condition and maintenanceType A
Official classification
Type A
Official code
87303(e)(2)
Regulation authority
CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in hot water at 137 degrees Fahrenheit which poses an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/11/2025 Plan of Correction Corrected. Staff adjusted the temperature to 120 degrees.

Plan of correction recorded
Correction not verified in available records
View official report
Hazardous items and storageType A
Official classification
Type A
Official code
87309(a)
Regulation authority
CCR

What the official deficiency says

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above inl lighter and peeler in kitchen cabinets without lock and bio hazard container in one of the residents' rooms which pose an immediate safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/11/2025 Plan of Correction Administrator locked the items. In addition, administrator to in-service the staff and submit copy of training topics with attendees signatures by 12/11/25.

Plan of correction recorded
Correction not verified in available records
View official report
Facility condition and maintenanceType B
Official classification
Type B
Official code
87303(a)
Regulation authority
CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the following which pose a potential safety and/or personal rights risksto persons in care: closet doors derailed; lavatory sink not properly draining; broken drawer knobs

Official plan of correction

POC Due Date: 12/24/2025 Plan of Correction Administrator to do the following and submit proof by 12/24/25: 1. Have the closet doors fixed. 2. Have the sink declogged. 3. Have the cabinet knobs replaced.

Plan of correction recorded
Correction not verified in available records
View official report
Health conditions and treatmentsType B
Official classification
Type B
Official code
87608(a)(3)
Regulation authority
CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and records review, the licensee did not comply with the section cited above in not having doctor's orders for R1 and R2's half bed rails which pose a potential safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 12/24/2025 Plan of Correction Administrator to obtain doctor's orders and submit copies by 12/24/25.

Plan of correction recorded
Correction not verified in available records
View official report
Complaint

Allegations0 substantiated · 1 unsubstantiated · 0 unfounded

No deficiencies recorded in this report
Inspection
Dementia careType A
Official classification
Type A
Official code
87705(f)(1)
Regulation authority
CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above for the following which pose an immediate health, safety and/or personal rights risk to persons in care: knives in the kitchen cabinets without lock; bleach, cleaning agents, and Comet cleanser in the Alarm Panel room without lock

Official plan of correction

POC Due Date: 12/08/2023 Plan of Correction Administor locked all the items. In addition, administrator to in-service the staff and submit training topic with attendees signatures by 12/08/23.

Plan of correction recorded
Correction not verified in available records
View official report
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
87411(c)(1)
Regulation authority
CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above for administrator's first aid certificate expired which poses a potential safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/21/2023 Plan of Correction Administrator to complete the training and submit copy of the certificate by 12/21/23.

Plan of correction recorded
Correction not verified in available records
View official report
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
87411(f)
Regulation authority
CCR

What the official deficiency says

87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition..... This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section in 3 out of 4 staff not having LIC503 Health Screening on file which pose a potential health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/21/2023 Plan of Correction Administrator to have the staff undergo Health Screening and submit copies of LIC503s by 12/21/23.

Plan of correction recorded
Correction not verified in available records
View official report
Staffing, personnel, and trainingType B
Official classification
Type B
Official code
1569.625
Regulation authority
CCR

What the official deficiency says

§1569.625 Staff training; legislative findings; contents (b)(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. . This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. S4 has only total of 21 hours training on file which poses a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/21/2023 Plan of Correction Administrator to have the staff complete the traning and submit self-certification by 12/21/23.

Plan of correction recorded
Correction not verified in available records
View official report

Source and limits

California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.

Read the data methodology