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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 074700161
Report Date: 11/05/2025
Date Signed: 11/05/2025 03:20:13 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
10/30/2025 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20251030085155
FACILITY NAME:CASWELL BAY INC DBA HILLENDALE HOME CARE INC.FACILITY NUMBER:
074700161
ADMINISTRATOR:JILL CABECIERASFACILITY TYPE:
300
ADDRESS:2950 BUSKIRK AVE. STE 200TELEPHONE:
(925) 933-8181
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:CENSUS: DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Joy Jervoso TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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HCO is not ensuring that Home Care Aides complete training requirements
INVESTIGATION FINDINGS:
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Enforcement Analysts (EAs) Megan Vigil and Yolanda Hankerson were greeted by the designee upon arrival for the purpose of a complaint investigation.

The most current payroll records were requested and reviewed by both EAs. The EAs also reviewed the Home Care Aides’ training records and noted that while initial training documentation was present, several required annual training components were missing.

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: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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-20251030085155
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: CASWELL BAY INC DBA HILLENDALE HOME CARE INC.
FACILITY NUMBER: 074700161
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2025
Section Cited
1796.44
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(a) A licensee shall ensure that prior to providing…services...shall complete the training requirements...prior to presence with a client...(b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific...
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The licensee must submit a complete audit record for all Home Care Aides (HCAs) listed on the requested payroll, confirming that all required annual training has been completed for 2024 and is available for Department review. The audit record must be submitted via email to megan.vigil@dss.ca.gov.
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Upon review of the training files, it was determined that some required annual training was missing. This poses a potential health and safety risk to clients in care.
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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: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
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