BLISSFUL HOME

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above as the facility is retaining bedridden residents in a room which is designated as non-ambulatory which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 07/21/2026 Plan of Correction Facility designee agreed to transfer resident from room #4 to room # 1 as room #1 has clearance to retain one bedridden resident.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 degrees C) and not more than 120 degree F (49 degrees 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 as hot water measured above the required range which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 07/17/2026 Plan of Correction During today's visit boiler was adjusted and water measured within required range. POC Cleared.

Official classification

Type B

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above as Administrator on record is not present at the facility during normal working hours which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Administrator shall be present at least 20 hours a week or submit paperwork assigning another person to take over administrator duties. A statement of understanding on this regulation or new administrator's paperwork shall be submitted to LPA before POC due date.

Official classification

Type B

Official code

87465(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (2) The exact dosage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above as medication logs were missing start dates which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Facility Designee will write a statement of understanding regarding this regulation and update the medication log. Documentation will be sent to LPA prior to POC due date.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 as one resident did not have a TB test result on file which poses/posed a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Test results will be sent to LPA prior to POC due date

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 as multiple reappraisal were not signed and/or current which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Signatures will be collected for missing reappraisals and a new updated reappraisal will be conducted for R1. All documentation will be submitted to LPA prior to 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 record review, the licensee did not comply with the section cited above as the only drill conducted was for earthquake and fire since 2019 which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction A list of new drills will be submitted to LPA before POC due date and those mentioned drills will be conducted quarterly.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above as R4 had bed rails that extended the length of the bed and they are not currently receiving hospice services which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Bed rails will be removed and 1/2 rails will only be present if R4 has a Drs order.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. 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 two restrooms where the hot water measured abovice 125 degree F, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/03/2025 Plan of Correction Licensee agrees to adjust the water temperature by 07/03/2025 and will maintain water temperature between 105- and 120-degrees Fahrenheit and submit proof to licensing.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above as R3's medications were being given eventhough they had been discontinued; one of their medications had not been filled, and start dates for medications were documented eventhough medications were not being given, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Licensee corrected all start dates during the visit and agrees to verify with R3's physician which medications should be taken and which medications are discontinued, will call pharmacy to follow up on medication refill, and will submit proof to licensing by 07/09/2025.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and nterviews, the licensee did not comply with the section cited above as interviews revealed residents are not being provided with activities and the LPA did not observe any activities during the visit which posesa potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction The licensee will submit their plan on how they will incorporate activities residents are interested in to CCLD no later than POC due date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. 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 as Resident 1 (R1) resident did not have a current appraisal/ needs and service plan on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Licensee agrees to update and reappraise R1. Administrator will submit proof of the reappraisals to CCL no later than 07/09/2025.

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...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.... 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 in one employee did not have proof of a negative TB test or health screening on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/09/2025 Plan of Correction Licensee agree they will submit proof of a negative TB test and health screening for the identified employee no later than POC due date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee failed to ensure the hot water temperature was within the required range (tested between 150.2-155.5 degrees F) which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Licensee agrees to adjust the water temperature by 07/26/2024 and will maintain water temperature between 105- and 120-degrees Fahrenheit. The Licensee shall submit proof of a 5 day water temperature log indicating the hot water is within the required range of 105-120 degrees F to CCLD by 08/01/2024. Licensee will also appropriately label the faucets as delivering hot water until fixed.

Official classification

Type A

Official code

87465(h)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidenced by: Deficient Practice Statement Based on medication review, the licensee did not comply with the section cited above for 1 (one) out of 3 (three) residents in which a prescribed melatonin medication indicated for bedtime use was administered in the morning before the visit which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/26/2024 Plan of Correction Licensee will ensure that all staff members are well-trained on medication administration and will review medication training. Licensee will ensure that proper medication logging techniques are used by staff. Licensee will read section 87465 and submit a letter of understanding to CCL by 07/26/202.

Official classification

Type B

Official code

87705(h)

Regulation authority

CCR

What the official deficiency says

(h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. 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 that 1 (one) out of 2 (two) side gates do not self-latch which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/05/2024 Plan of Correction Licensee will contact an appropriate handyman and request a quote for repairs to the gate. Licensee will submit either a quote for repairs to and a planned completion date or proof of repairs made to CCL no later than POC due date.

Official classification

Type B

Official code

87463c

Regulation authority

CCR

What the official deficiency says

(c) 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, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 in that 3 (three) out of 6 (six) residents did not have an updated/current appraisal needs and services plan which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2024 Plan of Correction Administrator agrees to update and reappraise the 3 (three) residents. Administrator will submit proof of the reappraisals to CCL no later than 08/01/2024.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.(2)Bedridden persons. This requirement is not met as evidenced by:

Official plan of correction

The administrator will issue a 30 day notice to R6 and R6's Public Guardian by 6/21/2023. The administrator will also ensure that in the meantime while R6 is still at the facility there is 24/7 awake staff to ensure the safety of all residents. Based on observation and interviews, the licensee did not comply with the section cited above as R6 is bedridden in a room without fire clearance for a bedridden resident, which poses an immediate health, and safety risk to persons in care.

Deadline recorded: Jun 21, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 degrees C) and not more than 120 degree F (49 degrees 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 as in the water temperature in resident bathrooms measured between 132.3 and 148.4 degrees F which poses an immediate health, and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/30/2022 Plan of Correction Administrator turned down water heater temperature during facility visit.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, as staff were observed without the appropriate face covering, which poses a potential personal rights risk to residents in care.

Official plan of correction

POC Due Date: 07/08/2022 Plan of Correction The Administrator agreed to do the following: 1. Hold an in-service training with all staff, reviewing masking guidelines. Submit sign in sheet to CCL no later than 07/08/2022.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as R3's medication was not administered as prescribed which poses an immediate health, safety and personal rights risk to resident in care.

Official plan of correction

Admin stated a new and updated medication list for R3. Admin will conduct additional medication training on all staff. Admin will provide new medication list and training materials to LPA via email : angel.ascencio@dss.ca.gov.

Deadline recorded: Apr 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia. (c)(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Based on resident records review the licensee did not comply with the section cited above as R1 and R2's reappraisal were not done annually which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Admin stated they will updated the reappraisals and present to POA for signatures. Admin to submit paperwork to LPA via email: angel.ascencio@dss.ca.gov

Deadline recorded: May 13, 2022. A deadline is not proof that correction was completed.