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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304700340
Report Date: 11/28/2023
Date Signed: 01/30/2024 04:44:00 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
05/02/2023 and conducted by Evaluator Ruben Perez
COMPLAINT CONTROL NUMBER: 47-HC-20230502114316
FACILITY NAME:ASSISTING HANDS YORBA LINDAFACILITY NUMBER:
304700340
ADMINISTRATOR:KOH, SHANAFACILITY TYPE:
300
ADDRESS:377 E. CHAPMAN AVE. SUITE 205TELEPHONE:
(949) 375-5029
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:CENSUS: DATE:
11/28/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Shana KohTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Home Care Aids did not recieve required training prior to caring for clients.

Home Care Aids did were not registered on the Home Care Aide Registry prior to caring for clients.

Home Care Aids did not have a TB clearance on file proir to caring for clients.

Home Care Aids did not have a fingerprint clearance or exemption prior to caring for clients.
INVESTIGATION FINDINGS:
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On 11/28/23, Analyst Ruben Perez arrived at the business address for Assisting Hands Yorba Linda. Licensee was not available on that date and Analyst Perez returned on 11/30/23 to complete the complaint investigation. Analyst Perez introduced himself and was greeted by Shana Koh. Analyst explained that he was there to investigate the above complaint allegations. Analyst Perez interviewed Shana regarding the company’s onboarding process for caregivers including background check and registration on the Home Care Aide (HCA) Registry. Analyst Perez also reviewed personnel files and payroll to ensure licensing requirements are met. The documentation demonstrated that certain caregivers were working prior to clearance on the Home Care Aide Registry.

Based on Analyst’s observations and interviews, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Article 7, Section 1796.43(a) is being cited on the attached LIC 9099D.
Analyst Perez concluded the visit with an exit interview and provided a copy of the HCS 9099 investigation report along with appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
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
Control Number 47-HC-20230502114316
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: ASSISTING HANDS YORBA LINDA
FACILITY NUMBER: 304700340
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/29/2023
Section Cited
1796.43. (a)
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1796.43. (a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients.

HCO did not ensure that all cargivers were cleared on the registry prior to client contact. This poses an immediate health and safety risk to clients in care.
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Scan proof of clearance and registration in the form of a screen capture from the Home Care Aide Registry Search site or a copy of your current personnel roster in Guardian showing Eligible-Clearance for all caregivers and email to Margo.Chipman@dss.ca.gov. Until proof of clearance and registration is provided, these caregivers must be immediately removed from shifts with clients.
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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: Wendy Scott
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2