Really fun experience, properly invokes both Bloodborne itself and the PSX aesthetic that is my sweet spot for nostalgia and that I'm thrilled to see more people beginning to embrace in their retro projects, but having played for a couple of hours I have to say that I think removing the bloodstain mechanic was a mistake. I take the point that a "pan-life" mechanic like soulsborne bloodstains might be a little "out there" for PSX-era design sensibilities, so removing it is probably authentic, but it's only when you lose it that you really realise how critical to the design formula (and definitely to Bloodborne specifically, which otherwise encourages aggressive and risk-taking play through mechanics that have been retained) it is. Respawning and knowing my lost echoes are gone for good discourages me from returning to where I died, which in turn over a long enough play session discourages me from committing to any single thing or having a coherent direction to play, which starts feeling unfun after a while.
I also think analogue stick support would probably be a fine accessibility addition (later PS1 games did have it, after all, so it's not completely inauthentic) but I don't know that I require it personally. Aside from that, this is everything I'd hoped it would be.
So it seems like this behaviour is a bug, and I think it has something to do with loading screens. I wasn't able to get a bloodstain to appear until I reached the Great Bonfire lantern, which has enemies in the same area as it. Dying to those enemies caused a bloodstain (or rather a blood infusion of one of the enemies) to appear, but dying in a nearby area one loading screen away caused there to be no bloodstain. This isn't consistent, it seems, since I was able to get a bloodstain a loading screen away in another case, but I never got bloodstains while working from the Central Yarnham lantern, which (as long as you're not going back down the ladder) requires you to go through a loading screen before encountering any enemies; and I died many times to those enemies.