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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700708
Report Date: 12/11/2024
Date Signed: 12/11/2024 10:34:53 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
09/10/2024 and conducted by Evaluator Ryan Chan
COMPLAINT CONTROL NUMBER: 47-HC-20240910121238
FACILITY NAME:ARCHANGEL CARE SERVICES LLCFACILITY NUMBER:
194700708
ADMINISTRATOR:REGALIZA, MARILENEFACILITY TYPE:
300
ADDRESS:5750 DOWNEY AVENUE, STE 301TELEPHONE:
(562) 252-2310
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:CENSUS: DATE:
12/11/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria Nonato - Officer In ChargeTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Home care aide is providing medical services to a client
INVESTIGATION FINDINGS:
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On 12/11/24, Home Care Services Branch Enforcement Analyst (EA), Ryan Chan arrived at Archangel Care Services to deliver the finding regarding the above complaint allegation. Upon arrival, EA met with Maria Nonato, Officer In Charge.

During the investigation EA reviewed the home care organization’s (HCO) client list, home care aide (HCA) staff list, and the service agreements of three clients. Additionally, EA interviewed the reporting party, the HCO owner Marilene Regaliza, the HCO designee Maria Nonato, and 13 HCAs. During the interviews, 5 of 13 HCAs admitted to checking clients’ blood pressure including 1 HCA who admitted to assisting a client with the maintenance of the client’s oxygen machine, which includes putting water, changing the filter, and cleaning the machine, then assisting the client put the oxygen mask on.

See pg 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 3
Control Number 47-HC-20240910121238
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: ARCHANGEL CARE SERVICES LLC
FACILITY NUMBER: 194700708
VISIT DATE: 12/11/2024
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 advised that only non-medical services can be provided by HCAs and provided a copy of Department of Social Services Fact Sheet for Medical Services to Maria Nonato. EA advised that all HCAs must stop any medical services being provided effective 12/11/24.

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

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 47-HC-20240910121238
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: ARCHANGEL CARE SERVICES LLC
FACILITY NUMBER: 194700708
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/18/2024
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.
This requirement is not met as evidenced by:
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EA spoke with Officer In Charge Maria Nonato 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 Wendy.Her@dss.ca.gov
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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 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3