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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700415
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:39:21 AM

Document Has Been Signed on 11/14/2024 11:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		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
ADMINISTRATOR/
DIRECTOR:		ANGELIKA MARIANOFACILITY TYPE:
300
ADDRESS:22996 EL TORO ROAD, SUITE 111TELEPHONE:
(949) 624-2446
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: CENSUS: DATE:
11/14/2024
Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Angelika Mariano, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted a case management visit due to discovery from interview with licensee and record review of the HCAs.

According to the licensee, the HCAs are given an option to received payments by 1099 or W2. Licensee stated 10 of 11 HCAs are currently paid via 1099 and 1 of 11 HCA receive payment via W2.

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 is emailed to the licensee.

LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my 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.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 11/14/2024 11:39 AM - It Cannot Be Edited


Created By: Mila Quinto On 11/14/2024 at 11:10 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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 B
11/21/2024
Section Cited
1796.42(b)
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1796.42(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides.
This requirement is not met as evidenced by:
Based on interview with licensee and record review, 10 of 11 HCAs were receiving a 1099. This poses a potential health and safety resk for 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.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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