BLISS CARE HOME

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(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 that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on documents, S2 and S4 have TB test results but do not have health screenings confirming their ability to perform their duties, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee stated they will obtain complete health screenings for these staff and submit proof to LPA by POC due date.

Official classification

Type B

Official code

87458(c)(7)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (7) A description of any known behavioral expression as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Deficient Practice Statement Based on documents, R4's physician's report is from January 2025 and is on the old form and does not have required information, including behavioral expressions, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 04/20/2026 Plan of Correction Licensee stated they will obtain a new physician's report on the new form for R4 and submit proof to LPA by POC due date.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, a staff has been living in the accessory dwelling unit (ADU) behind the garage for almost a month, but the ADU has not been fire cleared as a bedroom, which poses an immediate safety risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

POC Due Date: 01/10/2025 Plan of Correction Licensee stated they do not want to use the ADU as a bedroom and removed the beds during the inspection and LPAs confirmed. POC CLEARED.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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 facility did not ensure knifes, scissors, pesticides, dishwasher detergent, and other dangerous items were inaccessible to residents whose assessments do not allow for handling of such items, which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 01/10/2025 Plan of Correction During the inspection, Licensee removed these items and LPAs confirmed. Licensee to conduct training and submit proof to LPA by January 16, 2025.

Official classification

Type A

Official code

1569.17(c)(1)(A)

Regulation authority

HSC

What the official deficiency says

(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in a facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on Guardian documents and interviews, the licensee did not ensure staff John Ferdinand Senewe observed by LPAs at the facility, who lives at the facility and has worked here for almost a month, was background cleared as their status is pending in Guardian, which poses an immediate safety risk to persons in care. CIVIL PENALTY ASSESSED.

Official plan of correction

POC Due Date: 01/10/2025 Plan of Correction During the inspection, the staff stated this was their last day and they were moving out. Licensee removed this staff from the facility and LPAs confirmed. POC CLEARED.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on documents, the licensee did not maintain documentation of required training for 2 out of 2 staff, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2025 Plan of Correction Licensee stated they will train all staff as required and submit proof to LPA by POC due date.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and admission, the licensee has been administering supplements but does not have doctor's orders for these supplements, which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2025 Plan of Correction Licensee stated they will obtain doctor's orders for all supplements given to residents and submit proof to LPA by POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on documents and admission, the facility did not conduct emergency disaster drills quarterly in 2024 as they only conducted 3 drills in 2024, which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2025 Plan of Correction Licensee stated they will conduct a fire drill, submit proof to LPA by POC due date, and will conduct emergency disaster drills quarterly moving forward.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review .. shall prior to working, residing or volunteering in a licensed facility: … (2) Request a transfer of a criminal record clearance… This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not ensure S1 was associated to the facility prior to working at the facility, which poses a potential safety risk to persons in care.

Official plan of correction

Licensee stated they will associate S1 to the facility and submit proof to LPA by POC due date.

Deadline recorded: May 8, 2024. A deadline is not proof that correction was completed.