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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700937
Report Date: 08/28/2023
Date Signed: 10/05/2023 09:21:55 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
06/16/2023 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230616113042
FACILITY NAME:CARE SPECIALIST HCS INCFACILITY NUMBER:
194700937
ADMINISTRATOR:OMBRA, EDRISFACILITY TYPE:
300
ADDRESS:17050 CHATSWORTH ST #208TELEPHONE:
(818) 849-6415
CITY:GRANADA HILLSSTATE: ZIP CODE:
91344
CAPACITY:CENSUS: DATE:
08/28/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Omar OmbraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Home Care Organization (HCO) is working Independent contractors.
INVESTIGATION FINDINGS:
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On 8/28/2023, Associate Governmental Program Analysts (AGPA) Ramsey Chimienti met with Owner, Omar Ombra, of the Home Care Organization (HCO), Care Specialists Inc. DBA Premiere Home Care, located at 17050 Chatsworth St #208, Granada Hills, CA 91344, regarding the allegation above. Omar acknowledged the use of 1099 independent contractors and understood that every caregiver needs to be a W2 employee. In addition, 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. Based on AGPA's observations, interviews, and records review, 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, Article 7, Section 1796.37 (a)(5) is being cited on the attached LIC 9099D. A copy of the HCS 9099 and 9099D reports provided to licensee along with the appeal rights document.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
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-20230616113042
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: CARE SPECIALIST HCS INC
FACILITY NUMBER: 194700937
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2023
Section Cited
1796.37 (a)(5)
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Health and Safety Code § 1796.37 (a), (5) …requirements set forth in this chapter, including all of the following…Provides the department, upon request, with a complete list of its affiliated home care aides, and proof that each satisfies the requirements of Sections 1796.43, 1796.44, and 1796.45.
Mr. Ombra hired and worked independent contractors to care for clients, which did not meet requirements for Registered Home Care Aides. This poses an immediate health and safety risk to clients in care.
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Licensee will submit to the HCO Analyst, Marissa Bodine, proof of conversion of all 1099 independent contractors to W2 Home Care Aides which includes: Registry on the Home Care Aide Registry, TB clearance, Mandated Reporting, and documentation of required training. Please include your two most recent payroll reports, Quarterly DE9, and DE9C tax reporting forms. All documents must be submitted Marissa.Bodine@dss.ca.gov by the POC due date of 9/11/2023.
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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: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2