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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700112
Report Date: 09/19/2024
Date Signed: 09/19/2024 10:30:14 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
07/17/2024 and conducted by Evaluator Joshua Rarela
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240717092924
FACILITY NAME:1HEART CAREGIVER SERVICESFACILITY NUMBER:
194700112
ADMINISTRATOR:TAGARAO, KEVINFACILITY TYPE:
300
ADDRESS:16530 VENTURA BLVD STE 500TELEPHONE:
(818) 906-4441
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:CENSUS: DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Belina Calderon-NernbergTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
HCO is using independent contractors as caregivers
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an unannounced onsite inspection for the purpose of delivering findings of a Complaint Investigation. The EA met with the Home Care Organization (HCO) representative named above and discussed the allegation.

During the course of the investigation, the EA conducted interviews and reviewed records including HCO payroll records, Home Care Aide (HCA) pay stubs and HCA W-2 Wage and Tax statements. The records review revealed that the alleged independent contrator HCA was an employee of the HCO and received a W-2 from the HCO. The HCA's pay stubs also reflected that taxes were withheld. The former HCA confirmed to the EA that he received a W-2 from the HCO during his employment.

Based on the EA's observations, interviews and records review, there was insufficient evidence to prove the allegation as the preponderance of evidence standard was not met although the allegation may have happened or is valid, therefore the allegation is found to be unsubstantiated. An exit interview was conducted. A copy of this report and appeal rights were also provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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