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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304700351
Report Date: 09/18/2024
Date Signed: 09/18/2024 03:55:22 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
09/09/2024 and conducted by Evaluator Ryan Chan
COMPLAINT CONTROL NUMBER: 47-HC-20240909113900
FACILITY NAME:FIRST LIGHT HOME CARE OF IRVINEFACILITY NUMBER:
304700351
ADMINISTRATOR:CHARITH WEERASURIYAFACILITY TYPE:
300
ADDRESS:2400 BARRANCA PKWY # 1205TELEPHONE:
(949) 302-1047
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY:CENSUS: DATE:
09/18/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:CHARITH WEERASURIYA, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Home Care Aides do not have a criminal record clearance prior to caring for clients.
Home Care Aides do not have a tuberculosis (TB) clearance prior to caring for clients.
Home Care Aides are not approved on the Home Care Aide Registry prior to caring for clients.
INVESTIGATION FINDINGS:
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On 9/18/24, Home Care Services Branch Enforcement Analyst (EA), Ryan Chan conducted an investigation visit regarding the above complaint allegations. Upon arrival, EA met with home care organization (HCO) administrator Charith Weerasuriya.

During today’s visit, EA interviewed the administrator about their onboarding procedures. Administrator stated he has had issues with his care coordinators not properly completing their tasks during the onboarding of home care aides (HCA), those care coordinators are no longer with the HCO, administrator has hired a new care coordinator to oversee the onboarding process. EA reviewed HCA staff files which were determined to be missing documents. Administrator was advised that HCAs without proof of negative TB test and those who are not on the HCA registry are not to be with clients.

See pg 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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 5
Control Number 47-HC-20240909113900
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: FIRST LIGHT HOME CARE OF IRVINE
FACILITY NUMBER: 304700351
VISIT DATE: 09/18/2024
NARRATIVE
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Page 2

Based on EA's review of HCA files and interview with HCO administrator, 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 is being cited on the attached LIC 9099D.

EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the HCO administrator.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 47-HC-20240909113900
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: FIRST LIGHT HOME CARE OF IRVINE
FACILITY NUMBER: 304700351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2024
Section Cited
1796.23(a)
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1796.23(a)...Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision...
This requirement is not met as evidenced by:
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Scan proof of clearance 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 registered/eligible for all employees and email to stormy.yang@dss.ca.gov
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Based on documents reviewed licensee did not ensure background check was completed for home care aide (S2 and S3) which poses an immediate risk to clients in care.
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Type A
09/19/2024
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...
This requirement is not met as evidenced by:
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Scan proof of clearance 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 registered/eligible for all employees and email to stormy.yang@dss.ca.gov
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Based on documents reviewed licensee did not ensure home care aide (S2 and S3) were cleared on the home care aide registry prior to placing them with clients which poses an immediate 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 47-HC-20240909113900
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: FIRST LIGHT HOME CARE OF IRVINE
FACILITY NUMBER: 304700351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2024
Section Cited
1796.43 (a)(2)
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1796.43 (a)(2) Require home care aides to demonstrate that they are free of active tuberculosis disease, pursuant to Section 1796.45.
This requirement was not met as evidenced by:
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Scan completed TB clearance certifications for Home Care Aides to stormy.yang@dss.ca.gov
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Based on records reviewed licensee sis not ensure home care aides (S4, S5, and S7) were free from active tuberculosis prior to placing them in contact with clients which poses an immediate 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 47-HC-20240909113900
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: FIRST LIGHT HOME CARE OF IRVINE
FACILITY NUMBER: 304700351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2024
Section Cited
1796.44(b)
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1796.44(b)b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows...
This requirement is not met as evidenced by:
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Scan completed proof of training certifications for Home Care Aides to stormy.yang@dss.ca.gov
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Based on records reviewed licensee did not ensure home care aide (S7) completed 5 hours of entry level training prior to placing home care aide with client which poses a potential risk to clients in care.
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Type B
10/02/2024
Section Cited
1796.44(c)
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1796.44(c) (c) an affiliated home care aide shall complete a minimum of five hours of annual training.The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
This requirement is not met as evidenced by:
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Scan completed proof of training certifications for Home Care Aides to stormy.yang@dss.ca.gov
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Based on records reviewed licensee did not ensure home care aide (S6) completed a minimum of 5 hours of annual training which poses a potential 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5