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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 314700025
Report Date: 03/06/2023
Date Signed: 03/16/2023 10:56:19 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/29/2022 and conducted by Evaluator Michael Drake
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20220729090045
FACILITY NAME:AMOR CARE, INC.FACILITY NUMBER:
314700025
ADMINISTRATOR:HIDALGO, GABRIEL THOREAUFACILITY TYPE:
300
ADDRESS:3250 BLUE OAKS DR, STE 350TELEPHONE:
(916) 622-1653
CITY:AUBURNSTATE: ZIP CODE:
95602
CAPACITY:CENSUS: DATE:
03/06/2023
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Anne HidalgoTIME COMPLETED:
02:36 PM
ALLEGATION(S):
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HCA is not fingerprint cleared/exempted and registered to work
INVESTIGATION FINDINGS:
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On July 29, 2022, HCSA Todd Borcher spoke with licensee, Anne Hidalgo regarding the above complaint allegation.

The licensee admitted that Staff #1 did work a shift for the Home Care Organization (HCO), but is not currently working for the HCO. Licensee stated that she is unsure why the Staff #1 is still on the HCO roster, and would remove them. Additionally, the licensee stated that they would not schedule the Staff #1 until their status showed as "registered." A review of Guardian showed that Staff #1 was not cleared/exempted and registered at the time of their shift. Staff #1 was disassociated from the HCO on 08/03/2022.

Based on the HCSA's interview and research conducted, the preponderence of evidence standard has been met, therefor the above allegation is found to be SUBSTANTIATED. Health and Safety Code are being cited on the attached 9099D. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chong Vang
LICENSING EVALUATOR NAME: Michael Drake
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
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-20220729090045
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME: AMOR CARE, INC.
FACILITY NUMBER: 314700025
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2023
Section Cited
1796.14 (b)
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(b) An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client.

Licensee admitted Staff #1 worked a shift without being cleared/exempted on the Home Care Aide Registry.
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Licensee will remove Staff #1 from HCO roster and understands that Home Care Aides must be cleared and registered before having contact 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: Chong Vang
LICENSING EVALUATOR NAME: Michael Drake
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2