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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700365
Report Date: 01/31/2025
Date Signed: 01/31/2025 12:43:09 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
01/21/2025 and conducted by Evaluator Ryan Chan
COMPLAINT CONTROL NUMBER: 47-HC-20250121091820
FACILITY NAME:TENDER LOVING CARE CAREGIVINGFACILITY NUMBER:
194700365
ADMINISTRATOR:NAOMI GONZALEZFACILITY TYPE:
300
ADDRESS:1551 E CHEVY CHASE DR. #106TELEPHONE:
(818) 431-0599
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:CENSUS: DATE:
01/31/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Naomi Gonzalez - LicenseeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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HCO is arranging for the provision of medical services to clients
INVESTIGATION FINDINGS:
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On 1/31/25, Home Care Services Branch Enforcement Analyst (EA), Ryan Chan arrived at Tender Loving Care Caregiving and conducted an investigation visit regarding the above complaint allegation. Upon arrival, EA met with licensee Naomi Gonzalez.

During the investigation EA reviewed the home care organization’s (HCO) advertising and interviewed licensee. Licensee stated they provide non-medical services but also admitted that home care aides were checking and montoring client blood pressure. Licensee stated she did not know this was not allowed and will cease this prectice immediately.

EA advised that only non-medical services can be provided by home care aide HCAs and provided a copy of Department of Social Services Fact Sheet for Medical Services to licensee. EA advised that all HCAs must stop any medical services being provided effective immediately. Additionally, licensee stated the advertising for her HCO will be updated to reflect non-medical care being provided. (See pg 2).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
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 3
Control Number 47-HC-20250121091820
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: TENDER LOVING CARE CAREGIVING
FACILITY NUMBER: 194700365
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2025
Section Cited
1796.12(n)
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1796.12(n) Home care services means nonmedical services and assistance provided by a registered home care aide to a client who, because of advanced age or physical or mental disability, cannot perform these services. These services enable the client to
remain in his or her residence and include, but are not limited to, assistance with the following: bathing, dressing, feeding, exercising, personal hygiene and grooming, transferring, ambulating, positioning, toileting and incontinence care, assisting with medication that the client self-administers, housekeeping, meal planning and preparation, laundry, transportation, correspondence, making telephone calls, shopping for personal care items or groceries, and companionship. This subdivision shall not authorize a registered home care aide to assist with
medication that the client self-administers that
would otherwise require administration or oversight by a licensed health care professional.
This requirement is not met as evidenced by:
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EA spoke with licensee Naomi Gonzalez who
agreed to go over Health and Safety Code
1796.12(n) and review with the HCAs the
Department of Social Services Fact Sheet for
medical services and will have all current HCAs sign and date the Fact Sheet acknowledging they have read and understand the non medical services HCAs can provide.
The signed Fact Sheets will be emailed to Poyee.Vang@dss.ca.gov by 2/3/25.

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Based on the information obtained, it was
determined that HCAs are providing medical
services, licensee did not ensure that HCAs should not be providing medical services which poses an immediate risk to the Health and Safety of 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: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 47-HC-20250121091820
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: TENDER LOVING CARE CAREGIVING
FACILITY NUMBER: 194700365
VISIT DATE: 01/31/2025
NARRATIVE
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Page 2

Based on records reviewed, and interviews conducted, the preponderance of evidence standard has been
met, therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code, Division 2,
Chapter 13, Section 1796.12(n) is being cited on the attached LIC 9099D.

EA Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights to licensee Naomi Gonzalez.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3