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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700626
Report Date: 12/03/2024
Date Signed: 12/03/2024 01:55:42 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
10/03/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20241003141136
FACILITY NAME:FELICITY CARE GROUP, INC.FACILITY NUMBER:
194700626
ADMINISTRATOR:GARNER CRUZ JRFACILITY TYPE:
300
ADDRESS:17315 STUDEBAKER RD STE 205TELEPHONE:
(424) 319-9292
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:CENSUS: DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Garner Cruz, Jr.TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Home care aides are providing medical services
INVESTIGATION FINDINGS:
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Home Care Services Branch, Enforcement Analysts (EAs), Mila Quinto and Jane Cong-Huyen conducted an investigation visit to Felicity Care Group Inc. to deliver the complaint findings regarding the above allegation. EAs met with Garner Cruz Jr.

According to the interviews with the licensee and HCA, HCA assist the client with tube feeding by dispensing the machine and also disconnecting the machine. EAs reviewed documents showing HCA assist the client with the feeding tube and HCA provide a hands-on assistance.

Based on interview conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation are found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Section 1796.12(n). See HCS9099D
A copy of this report and appeals rights were provided to the licensee via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
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 2
Control Number 47-HC-20241003141136
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: FELICITY CARE GROUP, INC.
FACILITY NUMBER: 194700626
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2024
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.
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Licensee will submit a written plan of correction to ensure HCAs are only providing non medical services and email to Gabriella.Chavez@dss.ca.gov by 12/06/2024.
Also, licensee will review the Services Home Care Organizations and Home Care Aides May Provide Fact Sheet.
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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: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2