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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700976
Report Date: 10/16/2024
Date Signed: 10/17/2024 08:09:37 AM

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
07/23/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20240723154304
FACILITY NAME:HOME CAREGIVER COMPANIONFACILITY NUMBER:
194700976
ADMINISTRATOR:JENNIE LAMFACILITY TYPE:
300
ADDRESS:16881 SIMS LANE #ATELEPHONE:
(310) 648-2177
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY:CENSUS: DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jennie Lam, LicenseeTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Licensee financially abused client in care.
Licensee stole client's personal items while in care.
INVESTIGATION FINDINGS:
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2
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Home Care Services Branch, Enforcement Analyst (EA), Mila Quinto conducted an investigation visit to Home Caregiver Companion to deliver the complaint findings regarding the above complaint allegations. EA met with the licensee, Jennie Lam.

On 9/19/24, EA interviewed the licensee. According to licensee, there were 3 clients under the HCO (Home Care Organization) with 1 HCA (Home Care Aid) and 1 staff/adult to assist a client to transport in the bathroom for showering. There were no disclosures from the licensee regarding the allegations. Licensee also provided EA documents for review.
Based on interviews conducted and file review, the complaint alleging licensee financially abused client in care and licensee stole client’s personal items while in care are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Exit interview was conducted and a copy of this report and HCS9098 was emailed to Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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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