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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 014700109
Report Date: 04/01/2025
Date Signed: 04/09/2025 12:05:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2024 and conducted by Evaluator Ruben Perez
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20241114144709
FACILITY NAME:AGING IN PLACE HOME CAREFACILITY NUMBER:
014700109
ADMINISTRATOR:FORTUNE HUGHESFACILITY TYPE:
300
ADDRESS:3748 SELVANTE STREETTELEPHONE:
(925) 699-3788
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:CENSUS: DATE:
04/01/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Fortune HughesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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HCO did not ensure T.B. requirements were met for HCA prior to caring for clients.

HCO did not ensure HCAs have required entry-level training prior to caring for clients.

INVESTIGATION FINDINGS:
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On 4/1/2025, Enforcement Analyst (EA) Ruben Perez arrived at the business address for Aging In Place Home Care. EA Perez introduced himself and was greeted by Fortune Hughes. EA explained that he was there to investigate the above complaint allegation(s). EA Perez interviewed Fortune regarding the company’s onboarding process for caregivers including background check and registration on the Home Care Aide (HCA) Registry. EA Perez also reviewed personnel files and payroll to ensure licensing requirements were met. Licensee admitted to working family members of clients without state requirements because she thought they were exempt from those requirements. EA Perez was able to confirm an employee associated to the HCO provided services prior to having a TB test and entry level training.

Based on the EA’s observations and interviews, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Article 7, Section 1796.43(a) is being cited on the attached LIC 9099D.
Analyst Perez concluded the visit with an exit interview and provided a copy of the HCS 9099 investigation report along with appeal rights.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
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 2
Control Number 47-HC-20241114144709
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME: AGING IN PLACE HOME CARE
FACILITY NUMBER: 014700109
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/15/2025
Section Cited
1796.44 (a)
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1796.44 (a)
Health and Safety Code § 1796.44 (a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
A record of completion of the required training hours and topics was not documented in twelve of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses a potential health and safety risk to clients in care.

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Scan completed training logs for all twelve HCAs listed on the HCS859 and email to Derek.Milleman@dss.ca.gov by 4/15/2025.
Type A
04/15/2025
Section Cited
1796.45 (a)
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1796.45 (a)
Health and Safety Code § 1796.45 (a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. TB clearance was not documented in twelve of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
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Scan completed TB clearance certifications for all twelve HCAs listed on the HCS859 and email to Derek.Milleman@dss.ca.gov by 4/15/2025. Until TB clearance is received, these individuals must be removed from all shifts with clients.
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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: Wendy Scott
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2