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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334700206
Report Date: 02/06/2025
Date Signed: 02/06/2025 03:56:56 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
01/23/2025 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250123120311
FACILITY NAME:ELDER LOVE USA, INCFACILITY NUMBER:
334700206
ADMINISTRATOR:SHEA, SHANNONFACILITY TYPE:
300
ADDRESS:41550 ECLECTIC STREETTELEPHONE:
(888) 336-8322
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:CENSUS: DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Shannon Shea, LicenseeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Home Care Aides do not have a fingerprint clearance or exemption
Home Care Aides do not have a tuberculosis (TB) clearance
INVESTIGATION FINDINGS:
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On 2/6/2025, Home Care Services Branch Enforcement Analysts (EA), Jane Cong-Huyen and Mila Quinto conducted an investigation visit regarding the above complaint allegations. Upon arrival, HCSA met with the licensee, Shannon Shea.

During today's inspection, analysts interviewed staff and reviewed staff files. Based on observations and interviews conducted, 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 1796.43 (a)(1) Employees, Volunteers and Affliated Home Care Aide Requirements and 1796.45 (a) TB Testing; are being cited on the attached HCS 9099D.

EAs Cong-Huyen and Quinto concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the licensee, Shannon Shea.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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-20250123120311
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: ELDER LOVE USA, INC
FACILITY NUMBER: 334700206
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2025
Section Cited
1796.23(a)
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1796.23(a)(a) 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, unless exempt under subdivision (d). This requirement is not met as evidence by:
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EAs advised the licensee to ensured all staff must have fingerprint clearance prior to working with clients and handling files. Licensee will provide proof of fingerprint for 4 staff by Friday 2/14/2025 via email to analyst Mai.Her@dss.ca.gov.
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Based on interviews and 11 files reviewed, 4 out of 11 does not have fingerprint clearance. Licensee was not aware that some staff needed fingerprint clearance.
This poses an immediate health & safety risk to clients in care.
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Type A
02/07/2025
Section Cited
1796.45(a)
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1796.45 (a) TB Testing: (a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
This requirement is not met as evidence by: base on interviews and file reviews for 2 of the 11 files reviewed did not have TB clearance.
This poses an immediate Health & Safety risk to clients in care.
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EAs advised the licensee to ensured all staff must have TB clearance prior to working with clients. Licensee will provide proof of TB for 2 staff by day Friday 2/14/2025 via email to analyst Mai.Her@dss.ca.gov.
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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: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
01/23/2025 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250123120311

FACILITY NAME:ELDER LOVE USA, INCFACILITY NUMBER:
334700206
ADMINISTRATOR:SHEA, SHANNONFACILITY TYPE:
300
ADDRESS:41550 ECLECTIC STREETTELEPHONE:
(888) 336-8322
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:CENSUS: DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Shannon Shea, LicenseeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Home Care Aides are not approved on the Home Care Aide Registry
INVESTIGATION FINDINGS:
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On 2/6/2025, Home Care Services Branch Enforcement Analysts (EA), Jane Cong-Huyen and Mila Quinto conducted an investigation visit regarding the above complaint allegations. Upon arrival, HCSA met with the licensee, Shannon Shea.

The Department has investigated the complaint with the allegation listed above. Based on observations, interviews, and documents reviewed, EAs concluded that there was not enough evidence to show that the organization violated any of the allegations listed above, therefore, the above allegation is found to be UNSUBSTANTIATED.

EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the the licensee, Shannon Shea.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3