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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 074700059
Report Date: 08/21/2025
Date Signed: 08/25/2025 08:38:35 AM

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
08/15/2025 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250815145204
FACILITY NAME:IN-HOME CARE FOR SENIORSFACILITY NUMBER:
074700059
ADMINISTRATOR:OLIVA, OLIVERFACILITY TYPE:
300
ADDRESS:4180 TREAT BLVD SUITE A4TELEPHONE:
(925) 338-2399
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:CENSUS: DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alberto BernardinoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Home Care Organization does not ensure that Home Care Aides have TB clearances.

Home Care Organization does not ensure that Home Care Aides are on the registry.
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA) Megan Vigil arrived at the licensed location of the Home Care Organization (HCO) to conduct a complaint investigation.
EA Vigil was greeted by Licensee Alberto Bernardino and conducted an interview. EA Vigil requested the current payroll records of all Home Care Aides (HCAs) as well as the licensing requirement files for review. During the interview, Bernardino stated that they were unaware that the staff responsible for maintaining licensing requirements did not have all the documentation required for HCAs to provide services to the public. EA Vigil reviewed the requirements in detail with the Licensee and staff to ensure their understanding of the documentation process and the steps necessary to submit the Plan of Correction.
Based on the EA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated.An exit interview was conducted. The 9099 and 9099D reports, along with appeal rights, were provided to the Licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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-20250815145204
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: IN-HOME CARE FOR SENIORS
FACILITY NUMBER: 074700059
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2025
Section Cited
1796.45
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...(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease…
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The Licensee must submit a copy of the negative tuberculosis (TB) test via email to megan.vigil@dss.ca.gov for all the Home Care Aides (HCAs) referenced on the 08/01/2025 – 08/15/2025 payroll record by the POC due date of 08/28/2025.
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The Home Care Organization (HCO) did not have tuberculosis (TB) test records on file for its Home Care Aides (HCAs). This poses an immediate health and safety risk to clients in care.
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The Home Care Aides (HCAs) must be removed from all client shifts immediately until their tuberculosis (TB) test results are confirmed as negative.
Type A
08/28/2025
Section Cited
1796.43
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...(a) Home care organizations that employ
affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients...
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The Licensee must submit proof of clearance and registration for all Home Care Aides (HCAs) referenced on the payroll record. Either A screen capture from the Home Care Aide Registry Search site, orA copy of the current personnel roster in Guardian showing “Eligible – Clearance” for Staff #1. Submit to megan.vigil@dss.ca.gov by the POC due date of 08/28/2025.
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Home Care Aides (HCAs) were not cleared or deemed eligible on the Home Care Aide Registry prior to providing services to the public. This poses an immediate health and safety risk to clients in care.
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Until proof of clearance and registration is provided, the caregivers must be immediately removed from shifts with clients.
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: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2