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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 074700116
Report Date: 02/12/2025
Date Signed: 02/18/2025 10:44:45 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
01/09/2025 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250109132453
FACILITY NAME:ANGELS HEART HOME CARE SERVICESFACILITY NUMBER:
074700116
ADMINISTRATOR:PINKY LIBREAFACILITY TYPE:
300
ADDRESS:2603 CAMINO RAMON STE 200TELEPHONE:
(888) 976-0969
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:CENSUS: DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Pinky Librea TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Home Care Aide (HCA) does not have a cleared/eligible HCA registration while caring for clients.

Home Care Aide (HCA )does not have a fingerprint clearance prior to caring for clients.
INVESTIGATION FINDINGS:
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Home Care Services Branch (HCSB), Enforcement Analyst (EA), Megan Vigil arrived at location of Home Care Organization (HCO) for the purpose of a complaint investigation.

EA, Megan Vigil reviewed the most recent payroll and schedule, last DE9 Quartey report and personnel files. EA Vigil conducted interviews and verified details discovered in the requested documentation. Upon completion of the file review, AGPA Vigil discussed the findings of the inspection with the Licensee and advised deficiencies were found.

Based on AGPA's observations and interviews which were conducted and record review, 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 and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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-20250109132453
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: ANGELS HEART HOME CARE SERVICES
FACILITY NUMBER: 074700116
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/19/2025
Section Cited
1796.43
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(a) ...Organizations that employ affiliated home care aides shall ensure are cleared on the home care aide registry before placing the individual in direct contact with clients...
(1) Ensure any staff person, volunteer, or employee of a home care organization who has contact with clients, prospective clients, or confidential client information...before there is contact with clients or prospective clients or access to confidential client information.
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Scan proof of clearance and registration in the form of a screen capture from the Home Care Aide Registry Search site or a copy of your current personnel roster in Guardian showing Eligible-Clearance for the previously indicated caregivers and email to stormy.yang@dss.ca.gov by 02/19/2025.
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The indicated Home Care Aides (HCA) are currently working for the Organization are not cleared/eligible on the HCA registry. The indicated employees need to be fingerprinted. This poses an immediate health and safety risk to clients in care.
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Until proof of clearance and registration is provided, these caregivers must be immediately removed from shifts with clients.
Type A
02/19/2025
Section Cited
1796.23
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.. (a) Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d). Criminal Background Clearance and/or Exemption approval was not obtained for INDICATE_NUMBER of the caregivers on staff. This poses an immediate health and safety risk to clients in care.
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Scan proof of clearance and registration in the form of a screen capture from the Home Care Aide Registry Search site or a copy of your current personnel roster in Guardian showing Eligible-Clearance for the previously indicated caregivers and email to stormy.yang@dss.ca.gov by 02/19/2025.
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The indicated HCAs need to complete the fingerprint process and submit a HCA application. This poses an immediate health and safety risk to clients in care.
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Until proof of clearance and registration is provided, these 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: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2