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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920062
Report Date: 06/17/2026
Date Signed: 06/17/2026 11:20:45 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
03/24/2026 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20260324134221
FACILITY NAME:BLESSED HOMECARE 3FACILITY NUMBER:
345920062
ADMINISTRATOR:ARAMBULO, LERIZAFACILITY TYPE:
740
ADDRESS:6350 SAMOA WAYTELEPHONE:
(209) 834-4040
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
06/17/2026
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Daniel SmithTIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff hit resident resulting in bruising
Staff handled resident in a rough manner
INVESTIGATION FINDINGS:
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2
3
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5
6
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9
10
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12
13
Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Care staff Daniel Smith 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)
Page: 1 of 2
Control Number 59-AS-20260324134221
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 3
FACILITY NUMBER: 345920062
VISIT DATE: 06/17/2026
NARRATIVE
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Staff hit resident resulting in bruising

Interviews conducted indicated that R1 had bruises and scars on their body prior to moving in to the facility. R1 frequently sat back in their wheelchair hard which caused marks on R1’s back. Facility staff assisted R1 with one shower while R1 was residing at the facility and did not notice any new marks or bruises. Interviews with residents in care indicated that staff have never hit residents in care. Therefore, the allegation staff hit resident resulting in bruising is unfounded.

Staff handled resident in a rough manner

Interviews conducted with residents indicated that staff handle residents appropriately and help with each resident’s activities of daily living. Residents R2 and R3 indicated that staff do not handle them in a rough manner. Interviews conducted with Licensee and staff indicated that proper training is done and used to help with transfers and mobility throughout the facility. Records reviewed indicated that residents in care did not have any unexplained injuries or falls at the facility. Therefore, the allegation staff handled resident in a rough manner is unfounded.

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)
Page: 2 of 2