<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 092700822
Report Date: 09/09/2022
Date Signed: 09/09/2022 01:15:05 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2022 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220516104657
FACILITY NAME:BLISSFUL GARDENFACILITY NUMBER:
092700822
ADMINISTRATOR:JENNIFER SCARBERRYFACILITY TYPE:
740
ADDRESS:4210 PRODUCT DRIVETELEPHONE:
(530) 313-0364
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:25CENSUS: 15DATE:
09/09/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Motu SokimiTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Not enough staff to meet the needs of the residents
Questionable Death
Resident(s) developed a severe UTI while in care

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA visited the facility on 9/9/2022 to complete the complaint.
LPA has spoken with the Administrators, interviewed staff and residents, reviewed documentation.
Regarding the allegation of questionable death, the allegation was in reference to a resident who passed in May 2022. From interviews with 5 staff, and review of records LPA learned that R1 had an infection prior to passing. The resident was receiving hospice services. LPA learned that the facility had contacted hospice, that at first hospice was reluctant to do any medication, but upon repeated requests by the facility, antibiotic was started and administered to the resident. There is no evidence that facility staff did or did not do anything that might have contributed to the death. Therefore, the allegation is UNFOUNDED.
Regarding resident developing a UTI while in care, the allegation is not in and of itself a violation of a regulation. Through interview of four staff and review of records LPA learned of two different residents did have UTI’s in the spring. However, it appears that the facility staff did follow up with requesting medical attention, and the residents were given medications. Therefore, LPA finds nothing to substantiate any neglect on the part of the staff. Therefore, the allegation is UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
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 4
Control Number 25-AS-20220516104657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: BLISSFUL GARDEN
FACILITY NUMBER: 092700822
VISIT DATE: 09/09/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that there is Not enough staff to meet the needs of the residents, through interview of 5staff and 4 residents, LPA learned that there were times earlier in the year when staff called in or quit, when staff in the facility was short. LPA learned that there were times when outside agency staff was called in to assist. However, in speaking with staff and residents, LPA found no evidence to prove that the number of staff led to any resident’s needs not being met. Therefore, the allegation is UNFOUNDED.

A finding that the allegation is UNFOUNDED means that it is false, could not have happened, and/or is without a reasonable basis.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2022 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 25-AS-20220516104657

FACILITY NAME:BLISSFUL GARDENFACILITY NUMBER:
092700822
ADMINISTRATOR:JENNIFER SCARBERRYFACILITY TYPE:
740
ADDRESS:4210 PRODUCT DRIVETELEPHONE:
(530) 313-0364
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:25CENSUS: 15DATE:
09/09/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Motu SokimiTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unwitnessed falls resulting in injury due to lack of care and supervision.
Residents medical information was not accessible during an emergency.
Residents were left unsupervised while in care.
Methamphetamine (Crack) found by employee in employee bathroom.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13

Regarding the allegation that Resident sustained unwitnessed falls resulting in injury due to lack of care and supervision, through interview of 5 staff, 4 residents and review of records, LPA learned that there was at least one unwitnessed fall at the facility. Residents interviewed had no recollection of other residents falling. Resident R2 was reportedly walking independently from the bathroom to his bedroom, when he fell, and injured a finger. As per interview with staff, R2 was very independent and frequently refused to ask or wait for staff’s assistance. Regulation does not dictate that staff have “eyes on” all residents 24 hours per day. Residents are obviously entitled to privacy in their room, and staff cannot be there with them at all times. It appears that staff did their best to encourage R2 to request assistance. At this time it is not possible to say with certainty that more supervision would have prevented the fall. The allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 25-AS-20220516104657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: BLISSFUL GARDEN
FACILITY NUMBER: 092700822
VISIT DATE: 09/09/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that Residents medical information was not accessible during an emergency, from interview of 5 staff, LPA learned that the facility did have the information for residents. It appears that at the time of the alleged violation, the facility had just initiated a new process of printing out client’s information sheet from a computer. It is not clear exactly what happened at the time, but it is possible that staff present were not able to make the computer work correctly, and is not totally clear what might have taken place. LPA is not able to find conclusive evidence to prove what took place, and it appears adequate information was given to allow treatment. Allegation is UNSUBSTANTIATED.

Regarding the allegation that residents were left unsupervised while in care, from interview of 5 staff and 4 of 15 residents (LPA spoke with residents who were present in May when the complaint was filed, and who were able to recall incidents in May. There is no proof that there was any time when there were NO staff present in the home; it appears that at a minimum there was at least one licensee or staff there at all times. LPA is not able to conclude whether residents were “supervised” or “unsupervised” if there were individual staff in the facility. Therefore, the allegation is UNSUBSTANTIATED.

Regarding the allegation that Methamphetamine (Crack) found by employee in employee bathroom; again, LPA cannot ascertain that this in and off itself necessarily constitute a violation of a regulation. Also, from interviews of 5 staff, LPA learned that one employee did find a bag with a powdery white substance in the employee bathroom on the floor. The person in the room before that employee was from a temporary agency, was spoken to and never worked at the facility again. It is not proven that that particular person did or did not leave the substance in the bathroom. LPA learned that the staff bathroom is always kept locked, so residents do not have access to that room; therefore they did not have access to the substance. There is also no proof that any staff or anyone else actually used the substance, or if it actually was an illegal substance or what it was. Therefore, LPA is not able to prove whether there was or was not any effect whatsoever on any resident or their care from staff; however no issues have been reported. The allegation is UNSUBSTANTIATED.

A finding of Unsubstantiated means that although the alleged violation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Appeal rights provided, exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4