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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426277
Report Date: 07/29/2024
Date Signed: 07/29/2024 04:15:00 PM

Unfounded


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
12/10/2021 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20211210152136
FACILITY NAME:BLISSFUL CANYON HOMECAREFACILITY NUMBER:
336426277
ADMINISTRATOR:ROSALINDA ORLEANSFACILITY TYPE:
740
ADDRESS:1770 CENTURY AVE.TELEPHONE:
(951) 789-0170
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:6CENSUS: 4DATE:
07/29/2024
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Administrator, Linda OrleansTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee has failed to report the facility closure to the Department.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Linda Orleans and LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observation, interviews with staff members and residents, and records review.

On 12/10/2021, Community Care Licensing received a complaint alleging Licensee has failed to report the facility closure to the Department.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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 2
Control Number 18-AS-20211210152136
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 HOMECARE
FACILITY NUMBER: 336426277
VISIT DATE: 07/29/2024
NARRATIVE
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In regards to the allegation that Licensee has failed to report the facility closure to the Department, it was reported that the facility underwent a renovation and did not provide proper notification. LPA requested records of email correspondence and documentation pertaining to the facility. Licensee provided the information to the Department and resident’s 30-day eviction notices. LPA reviewed the 30-day eviction notices and signature from the 2 residents confirming the receipt of the document. Licensee stated that notice to the Department was provided on November 2, 2021. The assigned LPA at that time, confirmed the notice of the closure. This allegation is unfounded.

Based on LPA’s observation, interviews conducted, and record review, the allegations that Licensee has failed to report the facility closure to the Department is unfounded.This agency has investigated the complaint alleging Licensee has failed to report the facility closure to the Department. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was discussed with and provided to the Administrator, Linda Orleans.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2