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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304700117
Report Date: 08/22/2025
Date Signed: 08/22/2025 02:33:25 PM

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
06/25/2025 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20250625135245
FACILITY NAME:CAREZENFACILITY NUMBER:
304700117
ADMINISTRATOR:JAMIE PASCASIO-TRANFACILITY TYPE:
300
ADDRESS:16755 VON KARMAN AVE, STE 200TELEPHONE:
(800) 203-7158
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY:CENSUS: DATE:
08/22/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jamie Pascasio-Tran, LicenseeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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HCO is using independent contractors as caregivers
INVESTIGATION FINDINGS:
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Home Care Services Branch, Enforcement Analyst (EA), Mila Quinto conducted an investigation visit to the HCO to deliver the complaint finding regarding the above allegation. EA met with licensee, Jamie Pascasio-Tran.

On 7/25/25, EA interviewed the licensee. According to the licensee, they issue W2 payments to all the HCAs. However, licensee disclosed, 1 HCA was paid 1099 for the year 2023 and 2024 per the HCAs request.

EA obtained copy of payroll records, EDD reports wages, and 1099 form for 1 HCA for review.
Based on EA’s interview with the licensee and record review, the following violation is being cited in accordance with Health and Safety Code Health and Safety Code, Division 2, Chapter 13, Section 1796.42 (b). See HCS 809D.
A copy of this report and appeals rights were provided to the licensee via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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-20250625135245
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: CAREZEN
FACILITY NUMBER: 304700117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2025
Section Cited
1796.42(b)
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1796.42 License Posting, Insurance, and Abuse Reporting
(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides.
This requirement is not met as evidenced by:
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Licensee will submit a written plan of correction to indicate Licensee's plan to ensure all HCAs must receive W2 as form of payments and submit by August 29, 2025 and email to Mila.quinto@dss.ca.gov
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Based on interview and record review, HCA #1 was receiving pay via 1099.
This poses an immediate safety risk to clients in care.
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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: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
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