<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 124700004
Report Date: 01/03/2024
Date Signed: 02/06/2024 01:18:49 PM

Unsubstantiated


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
03/28/2022 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20220328100539
FACILITY NAME:AGAPE HOME CAREFACILITY NUMBER:
124700004
ADMINISTRATOR:TRENT ZELANICKFACILITY TYPE:
300
ADDRESS:321 W WABASH AVETELEPHONE:
(707) 445-1212
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:CENSUS: DATE:
01/03/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Amy ZelanickTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Home Care Aide is not registered prior to caring for clients.

2. Home Care Aide is not fingerprint cleared/exempted prior to caring for clients.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Home Care Services Bureau (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Agape Home Care on 1.3.24 at approximately 2:00PM and was greeted by Designee, Amy Zelanick.

AGPA Vigil conducted an annual inspection and discussed the complaint allegation. Upon completion of the file review, the details and information did not support what was mentioned against the Home Care Aide in question.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and the appeal rights were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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 1