Inspection
No deficiencies recorded in this report
BLOSSOM VALLEY CARE HOME 2
23 DECKER WAY, San Jose CA 95127
6 bedsLatest official report Jul 15, 2026Licensed
Additional info
- Telephone
- (408) 489-9173
- Licensee
- BLOSSOM VALLEY CARE HOME INC
- Administrator
- UBUNGEN, MAYBELLINE
- Contact
- UBUNGEN, MAYBELLINE
- License first date
- Jul 3, 2018
- License effective date
- Jul 3, 2018
- District office
- SAN JOSE RO · (408) 324-2112
- Regional office
- 26
- Clients served
- 935 - ELDERLY
Summary
The available records show 2 Type A and 4 Type B deficiencies for this facility.
- Most recent inspection
- Jul 15, 2026
- Most recent deficiency
- Jul 29, 2025
1 later report, on Jul 15, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
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 185 Santa Clara County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 5 reports for this facility: 5 inspections, 0 complaint investigations, and 0 licensing or administrative records.
Those records contain 2 Type A and 4 Type B deficiencies.
0 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 5
- Recorded deficiencies
- 6
- Type A deficiencies
- 2
- Type B deficiencies
- 4
- Substantiated complaints
- 0
- Repeated topics
- 0
About the same as most this size
1 in the last 12 months
More than the typical 3
0 in the last 12 months
More than the typical 1
0 in the last 12 months
More than the typical 2
0 in the last 12 months
Most this size also have none
0 in the last 12 months
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
Staffing, personnel, and trainingType B
- 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 observation, interview and record review, the licensee did not comply with the section cited above wherein 2 out of 3 staff members has not completed at least 20 hours of annual training in the topics of this section which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/05/2025 Plan of Correction Licensee will submit a statement of the section cited above to LPA Kabariti via email by POC due date of 08/05/2025.
Plan of correction recorded
Correction not verified in available records
Resident rightsType B
- Official classification
- Type B
- Official code
- 87467(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above wherein 1 resident files reviewed did not have an annual reappraisal and the last reappraisal was dated on 08/08/23 which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 08/05/2025 Plan of Correction Licensee will submit a statement of understanding of the section cited above, to LPA Kabariti via email by POC due date, 08/05/2025.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType A
- Official classification
- Type A
- Official code
- 87606(c)
- Regulation authority
- CCR
What the official deficiency says
(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not ensure to comply with their approved fire clearance for a bedridden resident wherein the bedridden resident was not residing in the master bedroom based on their fire clearance, which poses/posed a potential health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/30/2025 Plan of Correction Licensee will first talk with the family and states a plan to possibly move the resident to the master bedroom which is approved for bedridden resident, to comply with their fire clearance. Licensee will submit a statement of understanding of the section cited above to LPA Kabariti by 07/30/2025.
Plan of correction recorded
Correction not verified in available records
Health conditions and treatmentsType A
- Official classification
- Type A
- Official code
- 87608(a)(3)
- Regulation authority
- CCR
What the official deficiency says
(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, interview and record review the licensee did not comply with the section cited above wherein the licensee did not obtain a physician's order for 3 residents who utilizes half rails and 1 resident who uses full bed rails which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 07/30/2025 Plan of Correction Licensee will reach out to 4 residents physicians to request for an order for the bed rails. Licensee will submit a statement of understanding of the section cited above to LPA Kabariti by 07/30/2025.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87412(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The staff files were observed not completed in the facility.
Official plan of correction
POC Due Date: 08/08/2023 Plan of Correction Licensee agreed to submit the Plan of Correction by the POC due date to maintain the facility staff files completed.
Plan of correction recorded
Correction not verified in available records
Records and plan of operationType B
- Official classification
- Type B
- Official code
- 87506(b)(15)
- Regulation authority
- CCR
What the official deficiency says
(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The Resident Files were observed not completed in the facility.
Official plan of correction
POC Due Date: 08/08/2023 Plan of Correction Licensee agreed to submit the Plan of Correction by the POC due date to make the resident files completed.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this 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