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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214700036
Report Date: 07/09/2024
Date Signed: 07/10/2024 08:35:41 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
04/17/2024 and conducted by Evaluator Todd Borcher
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240417163230
FACILITY NAME:C3 SERVICES LLCFACILITY NUMBER:
214700036
ADMINISTRATOR:MARCIAL, JERICHOFACILITY TYPE:
300
ADDRESS:900 MISSION AVE STE 2TELEPHONE:
(415) 526-3380
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:CENSUS: DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Licensee - Cecil TiongTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is operating outside the terms and conditions of license.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 9, 2024, Home Care Services Branch (HCSB) Analyst, Todd Borcher, arrived at the business address for C3 Services LLC, located at 900 Mission Ave Ste 2, San Rafael, CA 94901. Analyst Borcher introduced himself and was greeted by licensee Cecil Tiong. The analyst explained that he was there to investigate the above complaint allegation.
Analyst Borcher interviewed licensee regarding the employees and caregivers the home care organization (HCO) hires. The analyst also reviewed personnel files and payroll documents to investigate the presence of 1099 employees. The documentation demonstrated that the Home Care Organization is utilizing W2 forms for all employees.
Based on the evidence obtained and interviews conducted, Analyst Borcher concluded that there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Analyst concluded the visit with an exit interview and provided a copy of the HCS 9099 investigation report along with appeal rights to the licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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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