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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005637
Report Date: 10/10/2025
Date Signed: 10/10/2025 12:01:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/15/2023 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20230215094013
FACILITY NAME:BLESSINGS SENIOR CAREFACILITY NUMBER:
306005637
ADMINISTRATOR:BROWER-GHAHYASI, JENNIFERFACILITY TYPE:
740
ADDRESS:724 S. BIRCHLEAF DRIVETELEPHONE:
(714) 396-4321
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 6DATE:
10/10/2025
UNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Glenn Navarro TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff failed to administer residents medications as prescribed
Staff do not maintain HVAC unit in good repair
Staff do not ensure that fire exits are free of obstruction
Staff did not seek medical attention for resident in a timely manner
Staff falsified resident's records
Staff did not ensure resident's hygiene needs are being met
Staff yelled at resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to investigate the above mentioned complaint allegations. LPA was greeted and granted entry by staff. LPA met with Operations Manager (OM) Glenn Navarro and discussed the purpose of the visit.

The investigation into the allegations of Staff do not maintain HVAC unit in good repair, staff do not ensure that fire exits are free of obstruction, staff did not seek medical attention for resident in a timely manner, staff falsified resident’s records, staff did not ensure resident’s hygiene needs are being met, staff yelled at resident, staff failed to administer residents medications as prescribed revealed the following:

Regarding the allegation Staff do not maintain HVAC unit in good repair, LPA observed an invoice from Nexgen dated March 2, 2023, stating maintenance and cleaning on the HVAC unit was performed. The HVAC unit was tested and found to be operational by a Nexgen technician.
Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
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 22-AS-20230215094013
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BLESSINGS SENIOR CARE
FACILITY NUMBER: 306005637
VISIT DATE: 10/10/2025
NARRATIVE
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During interviews with Staff #1 (S1) it was revealed that they never observed residents experiencing allergy symptoms due to the HVAC system. S1 informed LPA that they never observed dust coming from the vents and that they changed the filters monthly. Staff #2 (S2) revealed that there was no major work done to the air conditioning unit prior to March 2, 2023, besides routine filter changes. 2 of 2 staff informed LPA that staff change HVAC filters themselves. Therefore, the allegation has been deemed Unsubstantiated.

Regarding the allegation Staff do not ensure that fire exits are free of obstruction, LPA toured the physical plant and did not observe any obstructions at the time of the investigation, including in room #1. Two of two staff informed LPA that they do not recall obstructions at the facility, but if an obstruction is observed staff are to remove the obstruction immediately. Therefore, the allegation has been deemed Unsubstantiated.

Regarding the allegation Saff did not ensure resident’s hygiene needs are being met, LPA reviewed a physician’s report for Resident 1 ( R1) dated October 10, 2022, stating they have bowel and bladder impairment. The physicians report also states that R1 is unable to bathe themselves or care for their toileting needs. A needs and services plan was not produced to LPA upon request due to the facility not having R1s records. LPA reviewed four of four staff have current training on personal care services for residents. During interviews with R1s responsible party it was revealed that R1 was always clean. During interviews with S1 it was reported that staff checked on R1 every couple of hours and cleaned regularly. S1 reported they never observed a stench coming from R1. Therefore, the allegation staff did not ensure resident’s hygiene needs are being met is deemed Unsubstantiated.

Regarding the allegation Staff did not seek medical attention for resident in a timely manner, LPA observed a Bowel Movement Record for R1 for the month of January 2023. LPA reviewed records of R1s bowel movements and observed that on January 11th and 25th, R1 had a bowel movement with blood. Two of two staff informed LPA that they reported the bowel movements with blood to R1s Responsible Party. One of two staff informed LPA that R1s responsible party took them to the doctors due to the blood found in R1s stool. R1s Responsible Party informed LPA that they were not told about blood in R1s bowel movements but was struggling to remember. LPA did not observe documentation on reporting to R1s physician or responsible party. Therefore, the allegation has been deemed Unsubstantiated.

Continue on LIC9099C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230215094013
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BLESSINGS SENIOR CARE
FACILITY NUMBER: 306005637
VISIT DATE: 10/10/2025
NARRATIVE
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LPA observed staff training is current in regards to personal rights. It remains unclear if documentation of R1s bowel movement record was falsified with switching of dates from January 11th to noticing blood on January 25th. LPA only observed documentation where blood was observed on January 25th. Therefore, the allegations have been deemed Unsubstantiated.

Regarding the allegations Staff failed to administer residents medications as prescribed revealed the following: During record review it was revealed that Resident #2 (R2) was admitted to the facility on November 30, 2022. LPA observed a physician report for R2 dated November 23, 2022, stating that R2 cannot manage their medication. LPA observed a Resident Appraisal for R2 that was not dated and did not have signatures, stating that R2 needed help with medication. LPA observed a Medication Administration Record for R2 dated December 2022 where all medication was marked as given for the entire month.

During interviews with S1 it was revealed to their knowledge R2 was given all their medications. During interviews with R2s Responsible Party, it was revealed that to their knowledge there was no issues with the dispensing of R2s medication and that it was administered as prescribed. Two of two witnesses informed LPA that staff would alter medication based on R2s symptoms and stop medication even though they did not have doctors orders. Therefore the allegation, staff failed to administer residents medications as prescribed has been deemed Unsubstantiated.

LPA attempted to interview two of six residents in care and was unsuccessful. Two of two witnesses stated they do not have proof anymore due to the complaint being first reported a couple of years ago.

Based on information gathered, interviews and record review, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided at the time of the investigation.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3