194700726-2-25-2026-47-HC-SDUU-DRZPMH-20260309112619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 194700726
Report Date: 02/25/2026
Date Signed: 02/25/2026 08:31:18 PM

Unsubstantiated

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
02/06/2026 and conducted by Evaluator Joshua Rarela

PUBLIC

COMPLAINT CONTROL NUMBER: 47-HC-20260206160913

FACILITY NAME:	AROSA - SAN GABRIEL VALLEY		FACILITY NUMBER:	194700726
ADMINISTRATOR:	CYRIL VERGIS		FACILITY TYPE:	300
ADDRESS:	65 N. MADISON AVE, STE 106		TELEPHONE:	(323) 932-1300
CITY:	PASADENA	STATE: CA	ZIP CODE:	91101
CAPACITY:		CENSUS:	DATE:	02/25/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Stacie Ortiz, Area Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Home Care Organization (HCO) did not provide services to a client as contracted

INVESTIGATION FINDINGS:

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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Complaint Investigation. The EA met with the Home Care Organization (HCO) representative named above.

During the course of the investigation, EA interviewed HCO personnel and reviewed records such as the Home Care Aide (HCA) Job Duty Statements, HCA Training Records, HCA Registry, HCA Criminal Record Clearance and HCO Internal Documentation.

The investigation confirmed that Home Care Aides assigned to the client completed all mandatory training in compliance with Home Care Services Bureau statutes.

(CONTINUED)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 47-HC-20260206160913

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: AROSA - SAN GABRIEL VALLEY	FACILITY NUMBER: 194700726
	VISIT DATE: 02/25/2026

NARRATIVE

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(CONTINUATION)

Furthermore, the HCO maintained Job Duty Statements explicitly defining HCA responsibilities as strictly non-medical. Records indicate that the client received care within agreed parameters despite requesting tasks that exceeded the scope of home care services. One of the HCAs assigned to the client reported to the HCO that another HCA would acquiesce to the client's request to provide services outside the scope of their job duties, such as taking vital signs. Upon discovery of this violation, the HCO took immediate corrective action and the HCA’s employment is currently under review pending internal investigation.

Based on the EA's observations, interview and records review, there is insufficient evidence to conclude that the HCO failed to provide required services or willfully authorized the provision of services outside its regulatory scope. The allegation was found to be unsubstantiated as the preponderance of evidence standard was not met although the allegation may have happened or is valid. A copy of this report and appeal rights were provided via electronic mail.

SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026

LIC9099 (FAS) - (06/04)

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