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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600473
Report Date: 06/29/2026
Date Signed: 06/29/2026 04:40:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260624075110
FACILITY NAME:GEMLY'S HOME CAREFACILITY NUMBER:
198600473
ADMINISTRATOR:RODRIGUEZ, GEMMA A.FACILITY TYPE:
735
ADDRESS:1309 LA SERENA DRIVETELEPHONE:
(909) 967-6966
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:6CENSUS: 6DATE:
06/29/2026
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Violeta Tailan – DSP II
Mercedes Gutierrez - Care Staff		TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff are not cleared and/or associated to work in the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the
above-mentioned allegation. LPA met with Violeta Tailan, Direct Support Professional II (DSP II) and Mercedes Gutierrez, Care Staff and explained the reason for the visit. Administrator, Gemma Rodriguez was called on the phone and the purpose of the visit was explained.

The investigation consisted of the following: LPA conducted a tour of the facility, obtained copies of the Staff and Client rosters, Staff #1 (S1)'s files such as: Fingerprint clearance, Criminal record clearance, Staff schedule and Timesheets (September 2025 - December 2025). LPA interviewed Staff #2 (S2) - Staff #3 (S3), Staff #4 (S4) telephonically and Client #1 (C1) - Client #6 (C6).

The investigation revealed the following:
Regarding the allegation: "Staff are not cleared and/or associated to work in the facility." It is alleged that S1 was not cleared or associated with the facility, yet timesheets for September 2025-December 2025 documented hours worked.*****CONTINUED ON LIC9099-C*****
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
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 28-AS-20260624075110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GEMLY'S HOME CARE
FACILITY NUMBER: 198600473
VISIT DATE: 06/29/2026
NARRATIVE
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(2) of (3) staff interviewed confirmed that S1 worked in the facility mostly on weekends (Sat. & Sun.) in 2025. S2 stated that they started working in March 2026 and have never met S1. S4 stated that S1 was fingerprinted, but could not remember associating S1 via Guardian because they believed that after a staff is fingerprinted, they are automatically associated with the facility's roster. All (6) clients interviewed stated they knew S1 and had helped them with showers and prepared meals for them. LPA checked the staff association with Guardian, as well as Licensing Information System and S1 was not listed. Other documents reviewed revealed that S1 began working at the facility on September 8, 2025 and continued to do so until December 28, 2025, even tough S1 was not associated (via Guardian) in the facility. Therefore, there was sufficient evidence to corroborate with this allegation.

Based on LPA’s interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency cited on the attached LIC 9099D and an immediate civil penalty of $500 is hereby assessed.

An exit interview was telephonically conducted with the administrator, Gemma Rodriguez and a copy of this report was provided to Violeta Tailan, DSP II along with the Appeal Rights.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260624075110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GEMLY'S HOME CARE
FACILITY NUMBER: 198600473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/30/2026
Section Cited
CCR
80019(e)(3)
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80019 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f).
This requirement was not met evidenced by:
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Administrator to ensure that all staff obtain fingerprint/criminal record clearances and associated via Guardian prior to working or being present in the facility. S1 may not return to work until transfer is processed and associated with the facility.
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Based on interviews and records reviewed, the administrator did not comply with the section cited above in that Staff #1 (S1) was not associated with the facility which poses/posed an immediate health, safety or personal rights risk to clients in care.
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Administrator to submit S1’s clearances and proof of association via Guardian to LPA by POC due date. **Civil penalty was assessed in the amount of $500.00 **
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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.
SUPERVISOR'S NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3