198601356-7-2-2026-28-AS-WSHO-DVQQ3F-20260706114840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601356
Report Date: 07/02/2026
Date Signed: 07/02/2026 12:13:15 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/24/2026 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260624085920

FACILITY NAME:	GEMLY'S HOME CARE III		FACILITY NUMBER:	198601356
ADMINISTRATOR:	GEMMA RODRIGUEZ		FACILITY TYPE:	735
ADDRESS:	19002 HOLLYVALE DRIVE		TELEPHONE:	(626) 335-2151
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY:	6	CENSUS: 6	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Gemma Rodriguez		TIME COMPLETED:	12:25 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) Glenn Trueman conducted an unannounced complaint visit regarding the
above-mentioned allegation. LPA met with Care Staff S1 and explained the reason for the visit. Administrator, Gemma Rodriguez arrived shortly thereafter.

The investigation consisted of the following: LPA conducted a tour of the facility, obtained copies of the Staff and Client rosters, Reviewed Staff S1, S2 and S5's files and observed : Fingerprint clearance, Criminal record clearance, Staff schedule and Timesheets (July 2025 - December 2025). LPA interviewed Staff S1- Staff S4. Staff S5 is away in another country stated the Administrator.
Client's C1-C3 were interviewed. 3 clients were at Day Program at the time of visit.
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, S2 and Staff S5 were not cleared or associated with the facility, yet timesheets for July 2025-December 2025 documented hours worked.*****CONTINUED ON LIC9099-C*****

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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 28-AS-20260624085920

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GEMLY'S HOME CARE III	FACILITY NUMBER: 198601356
	VISIT DATE: 07/02/2026

NARRATIVE

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3 of 4 staff interviewed confirmed that S1 worked in the facility on call, but not for awhile.
Administrator stated S1 worked here a long time ago. Stated that S1 was associated 6/25/26.
Staff S1 stated that they were cleared and associated and started at Gemly's 3 first and was associated.
Review of Employee Time sheets reveal that S1 worked from 7/25 to 9/25 and was not cleared and associated.
S2 stated that they last worked at this facility on 6/30/25. Stated that they had clearance and was associated.
Administrator and Co-Administrator both stated that Staff S2 currently works at this facility and their last day worked was 6/30/26.
Review of Employee Time sheets reveal that S2 was hired on 2/1/2021 and Association ended on 1/22/25. Also time sheets reveal S2 working on 5/19/;26, 5/24/26,5/26/26, 5/31/26, 6/2/26 and 6/7/26.
3 of 4 staff interviewed confirmed that Staff S5 has not been here for about 6 months.
Administrator and Co- Administrator stated that S5 has not been here for a long time. Both said S5 has been away in another country.
Time sheets reveal 12/29/18 date of hire and Association ended 1/22/25. Also time sheets show S5 worked at this facility 9/25/11/25.
LPA checked the staff association with Guardian, as well as Licensing Information System and S5 was not listed.
All (3) clients interviewed stated they knew that Staff S1 and Staff S5 worked here awhile ago and that Staff S2 currently works here and worked here 2 days ago.

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 conducted with the administrator, Gemma Rodriguez and a copy of this report was provided along with the Appeal Rights.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260624085920

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GEMLY'S HOME CARE III	FACILITY NUMBER: 198601356
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 07/03/2026 Section Cited CCR 80019(e)(3)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	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, S2 and S5 may not return to work until transfer is processed and associated with the facility.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, the administrator did not comply with the section cited above in that Staff S1, S2 and S5 were not associated with the facility which poses/posed an immediate health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14	Administrator to submit clearances and proof of association via Guardian to LPA by POC due date. Civil penalty was assessed in the amount of $1500.00
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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.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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