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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304700415
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:38:49 AM

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
09/26/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20240926120132
FACILITY NAME:SAFE GUARD CARE SERVICES, INC.FACILITY NUMBER:
304700415
ADMINISTRATOR:SANDRA INCIPIDOFACILITY TYPE:
300
ADDRESS:22996 EL TORO RD STE 105TELEPHONE:
(949) 624-2400
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:CENSUS: DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Angelika Mariano, LicenseeTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Home Care Aides do not have a criminal record 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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Home Care Services Branch, Enforcement Analyst (EA), Mila Quinto conducted an investigation visit to Safeguard to deliver the complaint findings regarding the above allegations. EA met with the licensee, Angelika Mariano.

On 10/10/2024, EA interviewed the Licensee. The licensee stated they have 11 HCAs working. When hiring HCAs, licensee stated they provide a checklist of requirements as they must be completed prior to hiring. The checklist would include criminal record clearance and home care registry.

EA reviewed the 11 HCAs records and found 1 of 11 HCAs did not have fingerprint clearance and 3 of 11 HCAs did not have current home care registry.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 3
Control Number 47-HC-20240926120132
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: SAFE GUARD CARE SERVICES, INC.
FACILITY NUMBER: 304700415
VISIT DATE: 11/14/2024
NARRATIVE
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Page 1 of 2

Based on interview conducted and records reviewed, 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, Section Fingerprint Requirements 1796.23(a); Home Care Aid Requirements 1796.43(a). See HCS9099D

A copy of this report and appeal rights notice was emailed to the licensee.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 47-HC-20240926120132
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: SAFE GUARD CARE SERVICES, INC.
FACILITY NUMBER: 304700415
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2024
Section Cited
1796.239(a)
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1796.23(a) Fingerprint Requirements. Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department...
This requirement is not met as evidenced by:
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According to the licensee, HCA 7 is currently not working while the fingerprint and home care registry is in process. LIcensee will submit a written plan of correction to indicate Licensee's plan to ensure all HCAs have a cleared criminal background clearance and submit by 11/21/2024 to Poyee.Vang@dss.ca.gov
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Based on interview and file review, HCA 7 did not have fingerprint clearance. This poses an immediate health and safety risk to clients in care.
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Type A
11/21/2024
Section Cited
1796.43(a)
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1796.43(a) Affiliated Home Care Aide Requirements(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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According to the licensee, HCA7 and HCA 8 are currently on pending/in process status for the homecare registry and both are not working at this time. HCA11 is now active.
LIcensee will submit a written plan of correction to indicate Licensee's plan to ensure all HCAs have an active home care registry and submit by 11/21/2024 to Poyee.Vang@dss.ca.gov
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Based on interview and file review, HCA 7, HCA 8 and HCA 11 did not have a current home care registry. This poses an immediate health and 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: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3