304700278-7-24-2024-47-HC-WSCT-D7GUHJ-20240724153600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304700278
Report Date: 09/27/2023
Date Signed: 07/24/2024 03:10:35 PM

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
06/29/2023 and conducted by Evaluator Ruben Perez

PUBLIC

COMPLAINT CONTROL NUMBER: 47-HC-20230629153208

FACILITY NAME:	AMADA SENIOR CARE		FACILITY NUMBER:	304700278
ADMINISTRATOR:	JEFFERSON, TAFA		FACILITY TYPE:	300
ADDRESS:	24361 EL TORO RD STE 205		TELEPHONE:	(949) 528-3500
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:		CENSUS:	DATE:	09/27/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tafa Jefferson		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Home Care Services aranged were not provided to client.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Associate Governmental Program Analysts (AGPA) Ruben Perez arrived at the business address to meet with Tafa Jefferson, designee of Amada Senior Care at 901 Calle Amanacer Suite 300, San Clemente, CA to discuss the above complaint allegation. Designee, Tafa, greeted me at the door and let me in for an inspection of the organization.Tafa was able to provide documentation; service agreement, schedule, intake notes, daily visit notes, invoices, and emails from the daughter of client to show that services were not scheduled for dates indicated by the complainant.

Based on AGPA's observations and interviews, the AGPA concluded that there was not enough evidence that the organization was scheduled to provide services for certain dates indicated in the above allegation, therefore, the above allegation is found to be UNSUBSTANTIATED.

Analyst Perez concluded the visit with an exit interview and provided a copy of the report along with appeal
rights.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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