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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344700040
Report Date: 03/28/2024
Date Signed: 06/03/2024 04:16:35 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
02/21/2024 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240221110254
FACILITY NAME:GOLDEN YEARS HOME CARE SOLUTIONS, INC.FACILITY NUMBER:
344700040
ADMINISTRATOR:BALLARD, CARRIEFACILITY TYPE:
300
ADDRESS:8920 EMERALD PARK DR., STE D1TELEPHONE:
(916) 333-0383
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:CENSUS: DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Ken BallardTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Home Care Aides are not approved on the Home Care Aide Registry
Home Care Aides do not have a fingerprint clearance or exemption.
Home Care Aides have not completed the required training hours.
INVESTIGATION FINDINGS:
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Home Care Services Branch (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Golden Years In-Home Senior Care to discuss the above complaint allegation.

AGPA Vigil was greeted by Licensee, Ken Ballard. Ballard provided AGPA Vigil a copy of current payroll, staff files and a staff schedule for review. Upon completion of the review, AGPA Vigil learned staff were not registered on the HCA Registry and worked with clients in care.

Based on AGPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Health and Safety deficiencies cited on the attached reports and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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-20240221110254
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: GOLDEN YEARS HOME CARE SOLUTIONS, INC.
FACILITY NUMBER: 344700040
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2024
Section Cited
1796.23 (a)
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Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d).
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Scan proof of clearance and registration 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 the previously indicated employees and email to marisa.bodine@dss.ca.gov by 4.12.24.
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Homecare aides and employees are working with the public without the fingerprint clearance. This poses an immediate Health and Safety risk to persons in care.
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Until proof of clearance and registration is provided, these caregivers must be immediately removed from all shifts with clients.
Type A
04/12/2024
Section Cited
1796.43 (a)
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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.
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Scan proof of clearance and registration 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 the previously indicated caregivers and email to marisa.bodine@dss.ca.gov by 4.12.24. .
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Homecare aides and employees are working with the public without being cleared on the registry. This poses an immediate Health and Safety risk to persons in care.
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Until proof of clearance and registration is provided, these caregivers must be immediately removed from shifts with clients.
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: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 47-HC-20240221110254
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: GOLDEN YEARS HOME CARE SOLUTIONS, INC.
FACILITY NUMBER: 344700040
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2024
Section Cited
1796.44 (a)
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A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
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Scan completed training logs for the previously indicated employees to marisa.bodine@dss.ca.gov by 4.12.24.
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A record of completion of the required training hours and topics was not documented in the caregiver’s personnel records that were reviewed by HCSB analyst. This poses a potential 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: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
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