331880637-3-4-2026-18-AS-RORN-DRZPBK-20260309111029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880637
Report Date: 03/04/2026
Date Signed: 03/04/2026 01:13:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20231130084506

FACILITY NAME:	BLISSFUL CANYON HOME CARE II		FACILITY NUMBER:	331880637
ADMINISTRATOR:	ORLEANS, ROSALINDA		FACILITY TYPE:	740
ADDRESS:	284 ALDERWOOD WAY		TELEPHONE:	(951) 776-8351
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY:	6	CENSUS: 5	DATE:	03/04/2026
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	LInda Orleans		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident in care sustained unexplained injuries.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On March 04, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to the facility listed above. LPA met with staff Florence Groves, and the purpose of the visit was explained. LPA was granted entry to the facility. Later, LPA was joined by the Administrator (A1), Linda Orleans. LPA with Administrator toured the facility.

The investigation consisted of the following: On March 04/2026, LPA Richard reviewed and obtained the Resident roster (dated 12/29/25) and the Staff roster (dated 10/15/25). LPA obtained copies of Resident #1(R1) Admission Agreement (Dated 06/26/22), Pre-Appraisal (dated 06/26/22), Physician report (dated 07/23/23), Medication Administration Records (MAR), and Identification and Emergency Information: facility notes, and Unusual Incident Injury report (dated 11/28/23). On March 04/2026, LPA Richard interviewed the Administrator (A1), two staff members (S1-S2), four residents (R2-R5), and the responsible party (W1). LPA obtained a copy of the death report of R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

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 3

Control Number 18-AS-20231130084506

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BLISSFUL CANYON HOME CARE II	FACILITY NUMBER: 331880637
	VISIT DATE: 03/04/2026

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

Allegation: Resident in care sustained unexplained injuries.

The complaint alleged that the resident has a draining laceration to the elbow and mentions pain in the right arm, shoulder, and four different fractures at different stages of healing. On March 4, 2026, LPA Richard interviewed the Administrator (A1), who denied the allegations. A1 explained that the resident (R1) had a history of falls before admission to the facility. On November 28, 2023, staff noticed that R1's right shoulder and hand were swollen and that red fluid was draining from the area. The staff called Emergency Medical Services (EMS), and R1 was transported to the hospital. A1 also mentioned that the facility has a fall-prevention program in place for all residents at risk of falls.

On the same day, LPA interviewed two staff members (S1 and S2), who also denied the allegations. They stated that staff check on each resident every fifteen minutes, especially those who use walkers to move around. Additionally, LPA spoke with four residents (R2 to R5), all of whom reported that staff take good care of them and respond promptly when assistance is needed. LPA also interviewed the responsible party (W1), who denied the allegations, affirming that the facility staff takes excellent care of R1 and noted that R1 had a history of falls before being admitted to the facility.

Report continued on LIC9099C

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20231130084506

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BLISSFUL CANYON HOME CARE II	FACILITY NUMBER: 331880637
	VISIT DATE: 03/04/2026

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

On March 04, 2026, the LPA record review of the resident's appraisal dated 06, 22, 2022, showed R1 had a history of falls. LPA reviewed the Unusual Incident Injury Report that was sent to CCLD (dated 11/28/2023). LPA was unable to interview the Resident (R1), because R1 passed away in December 14, 2023.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

Exit interview conducted. A copy of the report was provided to the Administrator, Linda Orleans.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3