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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005637
Report Date: 05/16/2025
Date Signed: 05/20/2025 03:12:33 PM

Unfounded


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
06/14/2022 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 22-AS-20220614161146
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: DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Jennifer Brower-GhahyasiTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Staff yelled at resident
Facility did not ensure resident's dietary needs are being met
INVESTIGATION FINDINGS:
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13
Licensing Program Manager Victoria Bertozzi contacted facility to deliver findings regarding the above-mentioned complaint allegations and spoke with Jennifer Brower-Ghahyasi.

Staff yelled at resident – Complaint alleges that the manager of the facility picks on resident, R1 everyday for their hygiene and yelled at resident when urine dripped from their incontinence brief. Two of two staff interviewed, and five of five interviewed residents denied ever hearing manager yell at resident.

Facility did not ensure resident's dietary needs are being met – Complaint alleges that R1 does not like the facility's food and makes their own food on a burner in their room or orders fast food. Interviews revealed that R1 rented a room in the facility and was independent until they became a resident on June 18, 2022.

Continued on LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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 22-AS-20220614161146
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: 05/16/2025
NARRATIVE
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Continued from LIC9099

Per interview, R1 was permitted to eat the food provided by the facility but staff cannot stop R1 from eating food that does not comply with their low sodium and low sugar diet. During 6/22/2022 visit, LPA observed that R1 received a food delivery that they ordered themselves.

This agency has investigated the complaint alleging Staff yelled at resident and Facility did not ensure resident's dietary needs are being met. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
06/14/2022 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 22-AS-20220614161146

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: DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Jennifer Brower-GhahyasiTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident's hygiene needs are being met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Manager Victoria Bertozzi contacted facility to deliver findings regarding the above-mentioned complaint allegation and spoke with Jennifer Brower-Ghahyasi.

Staff did not ensure resident's hygiene needs are being met – Complaint alleges that R1 had an incontinence brief dripping from urine. Per interviews, R1 was independent in their incontinence care. Per manager when they observed the urine, they mentioned to the resident that they need to change their incontinence brief. Witness interviewed indicated that R1 was independent because they refused to comply with the facilities rules like showering, changing incontinence briefs, medications and food. Witness reported that resident is “visibly dirty” and their room smells of urine because they do not clean.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20220614161146
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: 05/16/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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32
Continued from LIC9099


Manager interview indicated that staff clean R1’s room when R1 allows it. Interviews revealed that R1 rented a room in the facility and was independent until they became a resident on June 18, 2022.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4