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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701323
Report Date: 12/24/2025
Date Signed: 12/24/2025 03:58:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2025 and conducted by Evaluator Sommer Hayes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250410153909
FACILITY NAME:HELPING HANDS CARE HOMEFACILITY NUMBER:
342701323
ADMINISTRATOR:OKORO, SYLVESTER O.FACILITY TYPE:
740
ADDRESS:8685 ELK WAYTELEPHONE:
(614) 747-3443
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
12/24/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Valesia ColeTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff did not dispense medication to resident as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sommer Hayes arrived unannounced to deliver findings on this complaint investigation. LPA Hayes met with Designated Facility Administrator, Valesia Cole and explained the purpose of the visit. The census is 6.
This investigation consisted of observation, interviews, and records review. Designated Facility Administrator Valesia Cole was interviewed, residents R3, R4 were interviewed and a record reviewed for R1 and R2.

First allegation: Staff did not dispense medication to resident as prescribed.
The investigation into this allegation consisted of interviews and record reviews of relevant documents.
A review of R2’s prescription record dated 4/18/2025 shows that Melatonin 3mg was ordered, with directions to take two tablets by mouth daily at bedtime. However, a review of R2’s medication administration records (MARs) show multiple missed doses.
Continued on 9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Sommer Hayes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2025
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 4
Control Number 27-AS-20250410153909
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/26/2025
Section Cited
CCR
87465(c)(2)
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87465 (c) (2)
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:
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By the Plan of Correction (POC) due date, the Licensee/Administrator email LPA Sommer Hayes with a training plan to sommer.hayes@dss.ca.gov. Including training dates and staff who will attend. This training will ensure that all staff who assist with medication administration receive updated training on proper medication administration practices to ensure that medications are administered in a timely manner and in accordance with each resident’s physician’s orders. After training is complete, Licensee/Administrator will email sommer.hayes@dss.ca.gov with training curriculum, training instructor and proof of attendance by staff.
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(2) Once ordered by the physician the medication is given according to the physician's directions. This was not met as evidence by: Based on interviews and observations, staff is not administering medications as prescribed by resident’s physician.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Sommer Hayes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20250410153909
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323
VISIT DATE: 12/24/2025
NARRATIVE
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In May 2025, Melatonin was not given on five different dates 5/25/25, 5/26/25, 5/27/25, 5/28/25,5/30/25 and 5/31/25. In June 2025, Melatonin was not given for 11 days in a row (6/1/25, 6/2/25, 6/3/25, 6/4/25, 6/5/25, 6/6/25, 6/7/25, 6/8/25, 6/9/25, 6/10/25 and 6/11/25 In July 2025, it was not given for 9 days in a row. 07/01/25, 07/02/25, 07/03/25, 07/04/25, 07/05/25, 07/06/25, 07/07/25, 07/08/25 and 07/09/25. Melatonin was not given on the following dates as evidence by the absence of staff initials and/or check marks used to indicate medications was given to R2.

During a medication review and interview on 7/30/2025 with LPA Arvin Villanueva and Designated Facility Administrator, Valesia Cole it was noted that the Melatonin on hand was 5mg tablets (photo taken), reported cutting the tablets in half, making the dose 2.5mg. The prescription records do not show an order to cutting the medication. Staff member also admitted they were not sure if the medication was given on the days left blank on the MARs. Staff explained that sometimes R2 did not receive Melatonin if R2 was already too sleepy from other medications, and that a family member instructed staff to hold the Melatonin under those conditions. However, the prescription order dated 4/18/25 does not state that the medication may be held for any reason. LPA Hayes attempted to interview R2, the resident was not cognitively available to participate in an interview.

The evidence shows staff did not consistently follow the physician’s order for R2’s Melatonin, and medication was either missed or altered without physician’s authorization. Therefore, the allegation is SUBSTANTIATED.

This facility is being cited per Title 22 CCR Section 87465(c)(2). An exit interview, appeal rights and a copy of this report was left with Valesia Cole.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Sommer Hayes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2025 and conducted by Evaluator Sommer Hayes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250410153909

FACILITY NAME:HELPING HANDS CARE HOMEFACILITY NUMBER:
342701323
ADMINISTRATOR:OKORO, SYLVESTER O.FACILITY TYPE:
740
ADDRESS:8685 ELK WAYTELEPHONE:
(614) 747-3443
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
12/24/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Valesia ColeTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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2
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Staff did not adequately assist resident with personal hygiene needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sommer Hayes arrived unannounced to deliver findings on this complaint investigation. LPA Hayes met with Designated Facility Administrator, Valesia Cole and explained the purpose of the visit. The census is 6.
This investigation consisted of observation, interviews, and records review. Designated Facility Administrator Valesia Cole was interviewed, residents R3, R4 were interviewed and a record reviewed for R1 and R2.
Second allegation : Staff did not adequately assist resident with personal hygiene needs.
Interview with Resident #3 (R3) on 9/9/25: Per interview, R3 indicated that he does not require assistance with personal hygiene. R3 stated that he receives assistance with medication management from staff. R3 stated he does not have problems with the food that staff serve to him.

Interview with resident (R4) on 9/9/25: Per interview, R4 indicated that he does not need assistance with bathing, indicating that he can perform personal hygiene independently. R4 stated that staff help him with taking his medications. R3 stated he does not have issues with the food service.
LPA Hayes attempted to interview Resident 1 (R1) regarding the above allegation; however, R1 was unable to provide information relevant to this allegation.
During the visit, Staff 1 (S1) reported that the facility began implementing a shower log in April 2025. LPA Hayes observed that shower logs were maintained for five of the six residents.
The facility did not maintain shower logs at the time Resident 00 (R00), who required hygiene assistance, resided in the facility. As a result, no documentation was available for review regarding R00’s hygiene care during that time period, and this information could not be included as part of the investigation.
The evidence does not indicate staff did not adequately assist with personal hygiene for residents. Therefore, the allegation is UNSUBSTANTIATED.
An exit interview and a copy of this report was left with Valesia Cole.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Sommer Hayes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4