Inspection Reports for Blossom Garden Senior Home
21307 Western Blvd, Hayward, CA 94541, CA, 94541
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, including the most recent annual inspection on December 10, 2024, which was clean. Earlier reports showed some deficiencies related mainly to environment and safety, such as unsecured knives and cleaning agents, expired first aid certification, missing staff health screenings, and insufficient training hours noted in December 2023. Infection control issues appeared in December 2021 with outdated signage, inadequate PPE supplies, and lack of fit testing, but no citations or enforcement actions were issued. A complaint investigation in November 2024 was unsubstantiated, and no fines or license actions were listed in the available reports. The facility’s record shows improvement over time, with the latest inspections demonstrating compliance and resolution of prior issues.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
2.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
43% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
78% occupied
Based on a December 2024 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 7
Capacity: 9
Deficiencies: 0
Date: Dec 10, 2024
Visit Reason
The inspection was an unannounced 1-Year Annual Required inspection conducted to evaluate compliance with licensing requirements.
Findings
The facility was found to be in compliance with no deficiencies cited. The inspection included a tour of the facility, review of resident and staff records, medication review, and verification of safety equipment and emergency plans.
Report Facts
Hot water temperature: 109.6
Fire extinguisher last serviced: Mar 22, 2024
Emergency disaster drill last conducted: Sep 16, 2024
Residents records reviewed: 5
Staff records reviewed: 5
Non-perishable food supply: 7
Perishable food supply: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Fekerte Hyesus | Administrator and Licensee | Met with Licensing Program Analyst during inspection |
| Ardalan Gharachorloo | Licensing Program Analyst | Conducted the inspection |
| Yvonne Flores-Larios | Licensing Program Manager | Named in report header |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 9
Deficiencies: 0
Date: Nov 5, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that the licensee was not cashing check payments for a resident's rent and was threatening eviction for non-payment.
Complaint Details
The complaint alleged that the licensee was not cashing check payments for resident R1's rent and threatened eviction for non-payment. The investigation found no staff with the initials A.A. who supposedly signed for the payments, and the licensee confirmed receipt of a cashier's check for the rent. The complaint was closed as unsubstantiated.
Findings
The investigation included interviews with the licensee-administrator and the resident's family member, as well as review of records and personnel reports. The allegation was found to be unsubstantiated due to lack of evidence that the alleged violation occurred.
Report Facts
Capacity: 9
Census: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Fekerte Hyesus | Licensee-Administrator | Interviewed during complaint investigation |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Bennett Fong | Licensing Program Manager | Named in report header and signature |
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 4
Date: Dec 7, 2023
Visit Reason
The visit was an unannounced annual required inspection conducted by the Licensing Program Analyst to evaluate compliance with regulations at Blossom Garden Senior Home.
Findings
The inspection found several deficiencies including unsecured knives and cleaning agents, an expired first aid certificate for the administrator, missing health screenings for some staff, and insufficient training hours for a staff member. Plans of correction were discussed and due by December 21, 2023.
Deficiencies (4)
Knives in kitchen cabinets without lock; bleach, cleaning agents, and Comet cleanser in the Alarm Panel room without lock.
Administrator's First Aid certificate expired 11/24/23.
Two staff members (S2 and S3) have no LIC503 Health Screening on file.
Staff member S4 hired in July 2023 has only 21 hours of training on file, less than required 40 hours.
Report Facts
Deficiencies cited: 4
Plan of Correction Due Date: Dec 21, 2023
Facility Capacity: 9
Facility Census: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Fekerte Hyesus | Administrator | Met with Licensing Program Analyst; named in findings related to expired First Aid certificate and plan of correction. |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 9
Deficiencies: 0
Date: Nov 11, 2022
Visit Reason
Licensing Program Analyst Delmundo conducted an unannounced infection control annual inspection to evaluate compliance with infection control and facility safety standards.
Findings
No deficiencies were observed during the inspection. The facility had adequate infection control measures in place, including screening stations, PPE supplies, and COVID-19 symptom screening. Hot water temperature and fire extinguisher maintenance were verified. The administrator provided updated infection control and liability documentation.
Report Facts
Hot water temperature: 105.2
Fire extinguisher service date: Nov 8, 2021
Number of pages: 9
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Fekerte Hyesus | Administrator | Met with Licensing Program Analyst during inspection |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 8
Capacity: 9
Deficiencies: 5
Date: Dec 9, 2021
Visit Reason
The inspection was an unannounced infection control annual inspection conducted as part of the required 1-year visit to evaluate compliance with health and safety regulations.
Findings
The facility had an approved COVID-19 Mitigation Plan and generally maintained infection control measures such as screening stations and PPE storage. However, deficiencies included outdated visitor posters, insufficient COVID-19 signage, inadequate disposable gowns and N95 respirators for staff, lack of fit testing for N95 respirators, and residents' temperatures no longer being routinely checked. No citations were issued during this inspection.
Deficiencies (5)
Visitor's poster at the entrance door outdated
No COVID-19 signages inside the facility except in the common bathroom and kitchen
Disposable gowns and N95 respirators not sufficient for 30 days for 5 staff
Staff are not fit tested for N95 respirator
Residents' temperature are no longer routinely checked
Report Facts
Capacity: 9
Census: 8
Liability insurance coverage: 3000000
Staff: 5
Days of nonperishable food supplies: 7
Days of perishable food supplies: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Fekerte Hyesus | Administrator | Facility administrator present during inspection and exit interview |
| Avelina Sagnep | Co-Administrator | Co-administrator who met with Licensing Program Analyst and provided information |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Named as Licensing Program Manager on the report |
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