<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344700040
Report Date: 01/30/2025
Date Signed: 02/04/2025 11:27:32 AM

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
01/03/2025 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250103125835
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:
01/30/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Carrie BallardTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCO did not ensure that staff are being properly trained.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Home Care Services Branch (HCSB), Enforcement Analyst (EA), Megan Vigil met with Carrie Ballard, Licensee of Home Care Organization (HCO) for the purpose of a complaint investigation.

EA, Vigil conducted interviews, inspected personnel files, and reviewed the relevant facts and findings through observation. Discrepancies were found related to the documentation provided from the personnel files.

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. An exit interview was conducted. The 9099 and 9099D reports and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 2
Control Number 47-HC-20250103125835
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: 01/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2025
Section Cited
1796.44
1
2
3
4
5
6
7
(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section. (b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client...(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training...
1
2
3
4
5
6
7
Licensee will conduct an audit of training documentation on file. The home care aides will sign a copy of the training log to confirm the trainings were completed by the individual. Scan a copy of training logs for all home care aides to your analyst, marisa.bodine@dss.ca.gov.
8
9
10
11
12
13
14
Licensee was unaware of the discrepancies found in the evidence provided during the investigation. This poses a potential Health and Safety risk to person in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2