198320406-9-9-2025-11-AS-UCOL-DPEVJH-20251216152842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320406
Report Date: 09/09/2025
Date Signed: 09/09/2025 04:25:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250902103108

FACILITY NAME:	BLESSED HANDS RESIDENTIAL CARE FACILITY FOR THE		FACILITY NUMBER:	198320406
ADMINISTRATOR:	TYSON, JANET		FACILITY TYPE:	740
ADDRESS:	17513 VALMEYER AVENUE		TELEPHONE:	(323) 218-1451
CITY:	GARDENA	STATE: CA	ZIP CODE:	90248
CAPACITY:	6	CENSUS: 1	DATE:	09/09/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Janet Tyson, Administrator		TIME COMPLETED:	04:51 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff spoke inappropriately to resident in care.
Staff do not provide adequate food service for the residents.
Staff are not assisting resident with bathing needs.

INVESTIGATION FINDINGS:

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

On 09/09/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. LPA was met by staff one, Janet Tyson - Administrator (S1), and the purpose of the visit was explained. The investigation consisted of the following: from 09:00AM through1:00PM, LPA requested facility resident roster and two (2) resident records which include resident face sheets (dated: various), physician's reports (dated:various), current assessments (dated: various), admissions agreements (dated: various), and crossover (shift change) log (dated: 08/15/25 through 09/01/25). During the same time period mentioned, LPA requested facility staff roster and two (2) staff records which include staff training(s) (dated: various) and any unusual incident reports (dated: 08/15/25 through 09/09/25), of which there were none. LPA also requested communications between the responsible party of Resident 1 (R1) and Janet (S1). From 10:00AM through 1:00PM, LPA interviewed three witnesses (W1-W3), one staff (S1) and attempted to interview resident two (R2). R1 no longer resides at the facility and is unavailable for interview. From 12:00PM to 1:00PM, LPA observed food storage and requested text messaging conversation between a responsible party and facility staff (dated: 08/13/25 through 08/25/25). Report continues, see LIC9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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 11-AS-20250902103108

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BLESSED HANDS RESIDENTIAL CARE FACILITY FOR THE	FACILITY NUMBER: 198320406
	VISIT DATE: 09/09/2025

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

The investigation revealed the following: Regarding the allegation, “Staff spoke inappropriately to resident in care.”, it is being alleged that a staff member has been observed yelling at a resident at least three (3) times. Interviews revealed the following: two (2) out of three (3) witnesses (W2-W3) and one (1) staff (S1) have denied the allegation has taken place. Resident two (R2) was not available for interview due to existing medical condition. R1 no longer resides at the facility and is unavailable for interview. Record reviews have revealed the following: Staffs one and two (S1-S2) have presented qualifications listed under Title twenty-two (22), division six (6), chapter eight (8), sections 87405, 87411 & 87412. Furthermore, S1 has completed "Person-Centered Thinking", which indicates S1 has been trained at observing a resident, rather than relying on hearsay. Based on interviews and record reviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation, “Staff do not provide adequate food service for the residents.”, it is being alleged that a resident has left the facility on a small breakfast, which resulted in this resident leaving the facility hungry. Interviews revealed the following: two (2) out of three (3) witnesses (W2-W3) and one (1) staff (S1) have denied the allegation has taken place. Resident two (R2) was not available for interview due to existing medical condition. R1 no longer resides at the facility and is unavailable for interview. Between 12:00PM and 1:00PM, LPA observed ample food storage, properly stored, along with food items that are low in sugar content which were to be provided to a resident in care. Furthermore, LPA reviewed text messages between S1 and responsible persons of a resident in care. Record reviews have revealed the following: Crossover (shift change) log have indicated staff have stayed attentive to resident(s) needs, including resident meals. All logs have noted the meals provided to R1, which indicate facility staff have made sure of R1 to have received nutritious and dietary fitting meals. Based on observation, interviews and record reviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation, “Staff are not assisting resident with bathing needs.”, it is being alleged that a resident had only received a shower one time per week (1x/week) instead of three times per week (3x/week), which they should be provided. Upon entrance to the facility, LPA observed the facility and did not detect any negative scent. Upon entrance to both bathrooms, LPA detected a clean scent and there was no mold/mildew present in the showers. Interviews revealed the following: two (2) out of three (3) witnesses (W2-W3) and one (1) staff (S1) have denied the allegation has taken place. Resident two (R2) was not available for interview due to existing medical condition... Report continues, see LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250902103108

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BLESSED HANDS RESIDENTIAL CARE FACILITY FOR THE	FACILITY NUMBER: 198320406
	VISIT DATE: 09/09/2025

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

R1 no longer resides at the facility and is unavailable for interview. Record reviews have revealed the following; Crossover (shift change) log has noted as follows: From 08/15/25 through 09/01/25, resident one (R1) has taken two (2) showers and refused one (1) shower, which indicate that R1 is offered a physical shower once (1x) every 5.66 days. Based on LPA observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with staff one, Janet Tyson - Adminstrator (S1), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3