342701323-6-17-2026-27-AS-LKIG-DVTN4H-20260709100755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701323
Report Date: 04/08/2026
Date Signed: 06/17/2026 10:06:46 AM

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
04/02/2026 and conducted by Evaluator Noel Wolf Petersen

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260402121455

FACILITY NAME:	HELPING HANDS CARE HOME		FACILITY NUMBER:	342701323
ADMINISTRATOR:	OKORO, SYLVESTER O.		FACILITY TYPE:	740
ADDRESS:	8685 ELK WAY		TELEPHONE:	(614) 747-3443
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 6	DATE:	04/08/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	valeisa cole		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff zip ties doors causing a safety hazard.
Staff mismanaging residents medications.
Staff do not refill residents medication prescription in a timely manner.

INVESTIGATION FINDINGS:

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**This report is ammended, originally designated as confidential but now corrected to be public. Text of this document is unchanged.**
Licensing Program Analyst, LPA Noel Wolf Petersen arrived unannounced to the facility 10am to open an investigation in to the above allegations as a complaint. LPA met with designated signatory Valeisa Cole and later sylvester okoro by phone to explain the purpose of the visit.
Physical inspection was conducted to investigate the zip tie situation of the doors. no doors were zip tied at the time of the physical inspection. Physical inspection had some locked food, no posted facility sketch with evacuation route, and no mattress encasements. One of the clients was doing some wandering behaviors, singing. LPA interviewed 2 residents, and 2 staff. consensus statement is that, a ziptie was used at least once to secure a door, the explination provided by staff is that a resident was expressing some behaviors while the staff on shift needed to use the bathroom, leading to a situation where a lack of staff necessitated a temporary restriction of the client's movement for thier own safety. LPA was shown five pictures of a door that seperates the resident rooms from the common area with zipties securing the door, the ties appear to be in different orientations and lengths indicating multiple times the door was ziptied. Continued on c Page.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

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-20260402121455

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: 04/08/2026

NARRATIVE

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LPA gave guidance that the staff should not be introducing obstructions to accessing the emergency exit, the facility should be assessing if it has the necessary staff to meet the needs of the clients instead.

In regard to medication mismanagement, in interviews with staff and clients, a consensus statement was reached that an error was introduced back in late december/early january, where a staff seemingly distributed a PRN medication as a daily medication. As the client had a very limited supply of that medication he was anxious about not having it if he needed it. that staff was let go, since the incident. The facility staff provided that the experinced staff was on vacation leave during this period, but had gone through an extensive medication audit recently where this error was discussed with the ombudsman.

Record review of the MARs by the LPA for the client indicated above had a period of 2 weeks where a drug went from prn to twice daily at some point in late december/ early january, and the majority of days it was not given and some days given at half dose. none of the required documentation exists for distributing it as a prn exists from this two week period.

Staff recalled a second situation that two medications not being refilled causing a gap in medication being delivered as perscribed 3/16/26 to 3/19/26, they brought the med refill issue to pharmacy, who introduced a delay where the doctor had an appropriate amount of time, but the doctor was having trouble signing into his online prescription pad delaying the medication filled and arriving to the pharmacy. LPA asked the staff in that situation to document what thier attempts were and follow up to those attempts. Staff did not take down documentation in that instance, but resolved to do so in the future.

LPA notes these incidents are related to a staff in a situation where there is not significant support from the administrator in the form of scheduling an adequate amount of staff for break relief and not sufficent training in medication administration for the staff. One resident claimed to only have seen the administrator twice in four months.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, is being cited on the attached LIC 9099D.)

Citations are issued as part of this visit. A copy of the report was read and given to the designated signatory of the administrator, a digital copy will be emailed to the address on file. appeal rights provided, exit interview was conducted.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20260402121455

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: 04/08/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/09/2026 Section Cited CCR 80072(a)(7)	1 2 3 4 5 6 7	80072 Personal rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(7) Not to be locked in any room, building, or facility premises by day or night.	1 2 3 4 5 6 7	LIC 500 will be sent to the LPA, to include adequate staff for supervision for break relief/at night by end of day on the POC date
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: interview with staff and clients where a ziptie is being used to lock a room in the facility, record review of 5 photos where zipties are being used to lock a door in the facility. not Following this requirement poses a risk to the health, saftey, and personal rights of a client.	8 9 10 11 12 13 14
Type B 04/29/2026 Section Cited CCR 87465(a)(1)	1 2 3 4 5 6 7	87465Inc idental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.	1 2 3 4 5 6 7	No Immediate POC, employee was let go, LPA asked that a signed afadavit of 87465 be sent to the LPA by the poc date
	8 9 10 11 12 13 14	This requirement was not met as evidinced by: Staff interview where staff claim they could not assist a client as necessary(refill medication) due to pharmacy/doctor action, the facility lacks documentation to support the claim, staff interview where ex-staff of the facility are claimed to have given a PRN as a regular medication instead of on an as needed basis, required PRN documentation for this period was not done and could not be reviewed. not following this requirement posed a risk to the health saftey and personal rights of clients in care.	8 9 10 11 12 13 14

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: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20260402121455

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: 04/08/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/29/2026 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	87405 Administrator - Qualifications and Duties (a)...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section...	1 2 3 4 5 6 7	LPA gave guidance the Administrator should get around 20 hours of administrator tasks a week, if thats going to be in addition to providing care, more hours would be approprite. sign an affadavit of understanding for section 87405 by the poc date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: A consensus statement from staff and clients they see the administrator less than 20 hours a week. Record review of at least one dementia client with a needs and services plan not being updated in the last year. Not following this requirement posed a potential risk to clients health, saftey and personal rights.	8 9 10 11 12 13 14
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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: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

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