315002812-6-17-2026-59-AS-LMUZ-DVDTWZ-20260625150623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002812
Report Date: 06/17/2026
Date Signed: 06/17/2026 09:18:36 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
05/12/2026 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20260512163158

FACILITY NAME:	BLESSED HOMECARE 2 ROSEVILLE		FACILITY NUMBER:	315002812
ADMINISTRATOR:	R		FACILITY TYPE:	740
ADDRESS:	4100 SHORTHORN WAY		TELEPHONE:	(209) 834-4040
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 5	DATE:	06/17/2026
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Baby Quintero		TIME COMPLETED:	09:25 AM

ALLEGATION(S):

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Resident has injuries of unknown origin

INVESTIGATION FINDINGS:

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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Licensee Baby Quintero to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***

Unfounded

Estimated Days of Completion: 10

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20260512163158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BLESSED HOMECARE 2 ROSEVILLE	FACILITY NUMBER: 315002812
	VISIT DATE: 06/17/2026

NARRATIVE

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Resident has injuries of unknown origin

Interviews conducted with Licensee and staff indicated that Resident R1’s bruises are explainable due to R1’s activities within the home. Observations indicated that R1 is active within the home and occasionally with run in to furniture and dig in drawers and cabinets. These behaviors are R1’s baseline and the facility will redirect as needed. Records reviewed indicated that R1 has continued to be at baseline in the care home with no concerns. Licensee, staff, R1's family and physician are aware of R1’s behaviors and continue to support R1.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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