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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530412
Report Date: 09/22/2026
Date Signed: 09/22/2026 03:06:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
06/16/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260616105546
FACILITY NAME:BLOSSOM GROVE ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
365530412
ADMINISTRATOR:ROODBAEI, SADAFFACILITY TYPE:
740
ADDRESS:11116 NEW JERSEY STTELEPHONE:
(909) 335-6660
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:66CENSUS: 59DATE:
09/22/2026
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sadaf Roodbaie TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are leaving the resident soiled in urine or feces
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver the investigative findings. Upon arrival, LPA met with Facility Administrator Sadaf Roodbaie and explained the purpose of the visit, which was to discuss the investigative findings regarding the allegation that is stated above.

First Allegation: Staff are leaving the resident soiled in urine or feces. Regarding the above allegation, LPA conducted a review of records pertaining to Resident #1 (R#1). Review of R#1’s Physician’s Report indicates that R#1 has bowel and bladder incontinence. LPA also reviewed R#1’s Needs and Services Plan, which indicates that R#1 is to be changed every two hours and as needed due to bowel and bladder incontinence. LPA conducted an inspection of R#1’s room. The room was observed to be clean and free of excremental odors. R#1 was observed to be clean and well groomed. LPA also observed that R#1’s hygiene was maintained. LPA interviewed Staff #1 (S#1) regarding the allegation that R#1 was being left soiled in urine and feces. S#1 denied the allegation and stated that R#1 is changed every two hours and as needed due to R#1’s bowel and bladder incontinence.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
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 2
Control Number 56-AS-20260616105546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BLOSSOM GROVE ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 365530412
VISIT DATE: 09/22/2026
NARRATIVE
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S#1 denied observing staff leave R#1 soiled in urine or feces for an extended period of time. LPA reviewed the facility’s staff rosters and observed that the facility had sufficient staffing to meet the needs of the residents in care. Based on the evidence obtained during the course of the investigation, LPA determined that the allegation is Unsubstantiated. An allegation is determined to be “Unsubstantiated” when the evidence obtained during the investigation does not establish, by a preponderance of the evidence, that the alleged violation occurred. Although the allegation may have occurred or may be valid, the evidence obtained during the investigation was insufficient to establish that the alleged violation occurred.

An exit interview was conducted where LIC 9099 report was discussed and provided to Facility Administrator Sadaf Roodbaie at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2