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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700643
Report Date: 05/14/2025
Date Signed: 05/14/2025 09:43:51 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
04/03/2025 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20250403122513
FACILITY NAME:LIVING GRACE ELDER CARE INCFACILITY NUMBER:
194700643
ADMINISTRATOR:BERNADETTE PEREZFACILITY TYPE:
300
ADDRESS:3241 PINE AVETELEPHONE:
(414) 499-7700
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:CENSUS: DATE:
05/14/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Bernadette PerezTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Home Care Aide did not complete the required training
INVESTIGATION FINDINGS:
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Home Care Services Branch, Enforcement Analyst (EA), Mila Quinto conducted an investigation visit to the HCO to deliver the complaint finding regarding the above allegation. EA met with licensee, Bernadette Perez.

On 4/24/24, EA interviewed the licensee. According to the licensee, they provide trainings to all the HCAs. EA inquired about HCA 1. Licensee stated, HCA 1 worked with HCO on/off for the last 3 years and HCA 1 was recently hired on November 24, 2024, to care for 1 client for 24 hours a day.
EA received a copy of HCA1’s file of which no training documents on file.
Based on interview conducted and records reviewed, 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 1796.44(a). 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: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
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 2
Control Number 47-HC-20250403122513
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: LIVING GRACE ELDER CARE INC
FACILITY NUMBER: 194700643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2025
Section Cited
1796.44(a)
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1796.44 Training Requirements (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:
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According to the licensee, they do not have a file for the training information for HCA1. However, HCA 1 is no longer working for the HCO.
Licensee will provide a written plan in place to ensure all HCA will receive the required training and maintain a file. Licensee will email the proof of correction wrtitten plan and email to stormy.yang@dss.ca.gov by 5/21/25.
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Based on interview and file review, licensee did not have the training requirements for HCA 1 available for review.
This poses an immediate 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: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2