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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700432
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:26:03 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
12/09/2022 and conducted by Evaluator Ryan Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20221209152632
FACILITY NAME:FILIPINO AMERICAN PERSONAL HEALTH CARE SERVICESFACILITY NUMBER:
194700432
ADMINISTRATOR:RANDALL AND MARILOU FROSTFACILITY TYPE:
300
ADDRESS:8671 WILSHIRE BLVD. STE 709TELEPHONE:
(323) 537-5733
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90211
CAPACITY:CENSUS: DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Marilou FrostTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The Home Care Organization has 1099 Home Care Aides
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/13/24 Home Care Services Analyst (HCSA), Ryan Chan conducted an investigation visit regarding the above complaint allegation. Upon arrival, HCSA met with licensee Marilou Frost.

The complainant alleged the Home Care Organization (HCO) employed 1099 workers.

During today’s visit, HCSA interviewed licensee who admitted she did employ workers as1099 because she was not aware that her Home Care Aide (HCA) employees needed to be W2.

Based on Analyst’s observations and interviews, 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 1796.42 (b) is being cited on the attached LIC 9099D.
Analyst Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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 2
Control Number 47-HC-20221209152632
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: FILIPINO AMERICAN PERSONAL HEALTH CARE SERVICES
FACILITY NUMBER: 194700432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
1796.42 (b)
1
2
3
4
5
6
7
1796.42 (b) A home care organization licensee shall do all of the following:
(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides.
1
2
3
4
5
6
7
Provide proof of conversion of all 1099 employees to W2 and send to your analyst for your HCO. Please include your payroll report and most recent DE9C tax reporting forms. Send to gabriella.chavez@dss.ca.gov
8
9
10
11
12
13
14
Based on interview with lcensee, she employed 1099 workers.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2