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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700515
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:53:33 AM

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
07/19/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20240719164447
FACILITY NAME:ANGELS ON DUTYFACILITY NUMBER:
194700515
ADMINISTRATOR:SOTO, CELIAFACILITY TYPE:
300
ADDRESS:15144 CARAVACA RDTELEPHONE:
(714) 927-6624
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:CENSUS: DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Favela, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Home Care Aides do not have a fingerprint clearance or exemption
Home Care Aides have not completed the required training hours
Home Care Aides are not approved on the Home Care Aide Registry
Home Care Aides do not have a tuberculosis (TB) clearance
Home Care Aides are administering medication to clients
INVESTIGATION FINDINGS:
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Home Care Services Branch, Enforcement Analyst (EA), Mila Quinto conducted an investigation visit to Angels on Duty to deliver the complaint findings listed above. EA met with Maria Favela.

On 8/29/2024, EA interviewed the licensee. The licensee stated they have a total of 8 HCAs including licensee. They only provide services to clients residing at The Palms Resident. On 9/6/2024, licensee provided payroll list from 1Q24 and 2Q24. According to the list, there were a total of 8 active HCAs including the licensee.
Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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 5
Control Number 47-HC-20240719164447
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: ANGELS ON DUTY
FACILITY NUMBER: 194700515
VISIT DATE: 10/03/2024
NARRATIVE
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The licensee stated part of the HCAs duties is assisting the clients with medications. Licensee states she works as an HCA and would assist in administering medication to the hospice clients when the nurse is not available and as long as the syringe medication is ready to be administer to the clients.

Licensee indicated prior to hiring HCAs, she verifies they have fingerprint clearance. According to the payroll list and interview with the licensee, 2 HCAs (HCA 2 and HCA 3) did not have criminal background clearance. There were 5 HCAs (HCA 1, HCA 2, HCA 3, HCA 4, and HCA 5) did not have a current Home Care Aid Registry.

On 10/3/2024, 4 HCA files were reviewed. According to the licensee only 6 active HCAs at this time. However, the licensee did not have files for 2 HCAs (HCA2 and HCA6). Based on the file review 6 of 6 HCAs did not have an updated annual training on file. Licensee stated have not done the annual training requirements. The 5 of 6 HCAs file did not have current tb clearance.

Based on interview conducted and records reviewed, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Section Fingerprint Requirements 1796.23(a); Home Care Aid Requirements 1796.43(a); Training 1796.44(a); TB 1796.45 and 1796.12(n) being cited on the attached LIC 9099D. EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights.

Exit interview was conducted and a copy of this report and HCS9098 was emailed to Licensee.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 47-HC-20240719164447
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: ANGELS ON DUTY
FACILITY NUMBER: 194700515
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2024
Section Cited
1796.23(a)
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1796.23 Fingerprint Requirements
(a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints..
This requirement is not met as evidenced by:
Based on interview with licensee and file review,
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Per licensee will have HCA2 obtain the fingerprint clearance and will not work until HCA2 receives a clearance.
Licensee will provide a written plan to ensure prior to hiring HCA must have be criminal background clearance by 10/10/24 to derek.milleman@dss.ca.gov
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HCA 2 and HCA3 did not have a crimianal background clearance. Licensee stated HCA 3 is no longer employed.
This poses an immediate health and safety risk to clients in care.
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Type A
10/04/2024
Section Cited
1796.43(a)
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1796.43(a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients.
This requirement is not met as evidenced by:
Based on file review,
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Licensee will ensure to have 5 HCA registered by today and or must not be in direct contact with clients.
Licensee will submit a written plan of correction to identify how licensee will correct this violation and what plans to take to prevent violations by 10/10/24 to derek.milleman@dss.ca.gov
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5 HCAs do not have home care registry.
This poses an immediate 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: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 47-HC-20240719164447
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: ANGELS ON DUTY
FACILITY NUMBER: 194700515
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2024
Section Cited
1796.44(a)
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1796.44(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
This requirement is not met as evidenced by:
Based on file review, 6 of 6 active HCAs did not have current trainings.
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Licensee will submit proof of training logs for all 6 active HCAs.
Licensee will also provide a written plan to ensure and avoid future violations by 10/10/24 and email to derek.milleman@dss.ca.gov
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This poses an immediate health and safety risk to clients in care.
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Type A
10/04/2024
Section Cited
1796.45(c)
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TB Testing 1796.45(c) ... an affiliated home care aide whose test for tuberculosis infection is negative shall be required to undergo an examination at least once every two years....
This requirement is not met as evidenced by:
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License will ensure to obtain copies of current TB test for the 5 HCAs. Licensee understands HCAs who do not have current TB clearance must not have direct contact with clients.
Licensee will also provide a written plan to ensure and avoid future violations by 10/10/24 and email to derek.milleman@dss.ca.gov
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Based on file review, 5 of 6 HCAs did not have a current TB clearance.
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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: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 47-HC-20240719164447
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: ANGELS ON DUTY
FACILITY NUMBER: 194700515
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2024
Section Cited
1796.12(n)
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1796.12(n)(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.
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Licensee will submit a written plan of correction to ensure all HCA are only assisting non medical care and will submt the written plan by 10/10/24 to derek.milliman@dss.ca.gov
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This requirement is not met as evidenced by:
Based on interview with licensee, they assist the nurse to administer medication already in the syringe.
This poses an immediate healty 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: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
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