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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334700070
Report Date: 05/25/2023
Date Signed: 06/02/2023 08:41:58 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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
12/14/2022 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20221214093358
FACILITY NAME:JULIE'S IN HOME CAREFACILITY NUMBER:
334700070
ADMINISTRATOR:JULIE MARTINEZFACILITY TYPE:
300
ADDRESS:37957 GALLERY LANETELEPHONE:
(951) 544-0924
CITY:BEAUMONTSTATE: ZIP CODE:
92223
CAPACITY:CENSUS: DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Julie MartinezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Working Home Care Aides (HCAs) who are not registered.
INVESTIGATION FINDINGS:
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On 5/25/23, Analyst Ramsey Chimienti arrived at the business address for Julie’s In Home Care. Analyst Chimienti introduced himself and was greeted by Julie Martinez. Analyst explained that he was there to investigate the above complaint allegation. Analyst Chimienti interviewed Ms. Martinez regarding her company’s onboarding process for caregivers including background check and registration on the Home Care Aide (HCA) Registry. Analyst Chimienti also reviewed all personnel files to ensure licensing requirements are met. Based on Analyst’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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-20221214093358
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: JULIE'S IN HOME CARE
FACILITY NUMBER: 334700070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2023
Section Cited
1796.43
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Health and Safety Code § 1796.43 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. Staff #1 and #2 did not have a clearance on the Home Care Aide registry and Staff #3 had an expired registration. This poses an immediate health and safety risk to clients in care.
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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 Eligible-Clearance for Staff #1, #2, and #3 and email to Gabriella.Chavez@dss.ca.gov by 6/26/2023. 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: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2