Blessed Hands Residential Care Facility for the

Type of visit: Required - 1 Year

On 11/6/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit. LPA met with the Administrator, Janet Tyson and explained the purpose of today’s visit. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. The facility is licensed to serve 6 ambulatory residents only (age range 60 and over). The census is currently 2. Blessed Hands Residential Care is a one-story structure located in a residential neighborhood. The facility consists of (4) bedrooms, one private bedroom and three (3) client bedrooms, two (2) full bathrooms, living room, dining area/small office, kitchen, washer and dryer appliances are located in the kitchen. Shaded patio, and the garage is used for storage. Facility maintains all required posting throughout the facility. LPA conducted a records review of (2) client records, (2) staff records, and (2) client medications. All client & staff records were complete. LPA Shirley and Janet walked through throughout the facility and all common areas such as the living room, dining room, and outdoor patio were all observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water delivered at 117.3 F. LPA observed that there is ample seating and space for all clients. All walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. Smoke/ Carbon Monoxide detectors were operable. There is (1) charged fire extinguisher. Exterior areas are clean and clear of obstructions and hazards and there are no bodies of water present. No deficiencies were cited during this inspection visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Janet Tyson.the state’s words, verbatim · CDSS document, Nov 6, 2025

Allegation investigated: 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.

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 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. 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.the state’s words, verbatim · CDSS document, Sep 9, 2025 · control 11-AS-20250902103108

Type of visit: Required - 1 Year

On 11/21/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required annual visit using the full CAREs Inspection Tool. LPA met with Administrator, Janet Tyson and explained the purpose of today’s visit. The facility is licensed to serve elderly developmentally disabled residents ages 60 and over. This facility has a approved fire clearance for six (6) ambulatory only residents. Approved hospice waiver for two(2) hospice residents. There are no residents in placement at this time. LPA reviewed the Administrator's personnel file and found that it contained all required documents. During file review, LPA observed the liability insurance. LPA Felisa and Janet toured both inside and outside of the facility. The facility is a one-story structure located in a residential neighborhood. The facility consists of (3) client bedrooms, (1) staff bedroom, (2) bathrooms, living room, kitchen, dining area, and patio. Facility maintains all required posting throughout the facility. All bedrooms were toured. Bedrooms 1-3 will be occupied by residents and contain the mandated furniture. LPA observed all rooms to have the required furniture including a bed, nightstand, and chair(s). All beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed ample lighting in all the bedrooms. LPA Shirley and Janet toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored. The medication cabinet was locked and located in the kitchen. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The (2) bathrooms are clean and operational. First aid kit is fully stocked with manual. The Administrator owns a gun and the bullets are stored separately from the gun. There are no bodies of water present. This facility is in good repair. Con'd 809-C LPA Shirley and Janet walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all residents. All rooms and walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. All rooms, hallway, and living room have working smoke detectors. There is a charged fire extinguisher in the kitchen. The backyard is clean and clear of obstructions and hazards, and there are no bodies of water present. There are no deficiencies observed. An exit interview was conducted, and a copy of this report was provided to Administrator, Janet Tyson.the state’s words, verbatim · CDSS document, Nov 21, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Felisa Shirley made an announced visit and met with applicant/ administrator Janet Tyson to conduct a Pre-Licensing evaluation. The requested capacity is for six (6) ambulatory clients. Structure: Facility is a one story family home with four bedrooms, one private bedroom and three (3) client bedrooms, two (2) full bathroom, living room, dining area/small office, kitchen, washer and dryer appliances are located in the kitchen. A locked file cabinet located in the dining room will be used to store client and staff files. First aid kit, and first aid manual will be stored on a shelf located above the washer and dryer. There are two exits, main exit is located in living room, and exit two (2) is located off of the dining room. Front yard landscape is in good condition at time of visit. Bedroom Residents: Bedrooms are equipped with one bed per client, nightstand, chair, and one lamp. LPA observed activities available for clients. Bathrooms: Two (2) bathrooms have a working toilet, wash basin, and a bathtub/ shower, LPA observed grab bars and non-slip strips. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Two (2) fully charged fire extinguishers located in the kitchen and dinning room. LPA observed sufficient hygiene supplies for clients. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in the locked medication cabinet. Smoke Detectors/Carbon Monoxide(s): Facility is equipped with operational dual and hardwired smoke detectors in all bedrooms and mounted on the ceiling. LPA observed three day perishables, and seven days plus supply of non-perishable food. Appliances: Stove burners (electric), oven, microwave, and washer/dryer are in working condition. There is one working (1) refrigerator in the home and one (1) freezer located in the garage. Cont'd on 809-C Component III was reviewed with applicant/ administrator Janet Tyson, who is familiar with tittle 22 regulations. During the pre-licensing inspection zero (0) items were observed that didn’t comply with applicable laws and regulations. LPA reminded applicant the following items shall be posted always: Emergency numbers, Personal rights, Emergency Disaster Plan, Complaint Procedures, and facility sketch show emergency exits. An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst. Applicant advised to contact LPA when first clients becomes admitted to facility.the state’s words, verbatim · CDSS document, Oct 25, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Janet Tyson (Licensee/Administrator) Interview Method: Virtual interview via Microsoft Teams On October 12, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 12, 2023