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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344700054
Report Date: 05/14/2024
Date Signed: 05/14/2024 10:27:11 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
04/22/2024 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240422162502
FACILITY NAME:NURSE NEXT DOORFACILITY NUMBER:
344700054
ADMINISTRATOR:KRANDIP SAMRANFACILITY TYPE:
300
ADDRESS:3112 O STREET STE 1TELEPHONE:
(916) 524-7020
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY:CENSUS: DATE:
05/14/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Karian SamranTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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1. Home Care Aide did not have a criminal record clearance prior to caring for clients.

2. Home Care Aides are not registered on the Home Care Aide Registry prior to caring for clients.
INVESTIGATION FINDINGS:
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Associate Governmental Program Analyst (AGPA) Megan Vigil, arrived at the location of Nurse Next Door regarding the above complaint allegation.

AGPA Vigil identified herself and was greeted by Licensee, Karian Samran. Karian acknowledged there were home care aides (HCAs) that did not have an eligible/cleared status. Licensee removed all HCAs from providing services prior to the complaint. It is determined that all HCA registry statuses are cleared and eligible.

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. A copy of the reports, deficiencies, and appeal rights were provided.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
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 2
Control Number 47-HC-20240422162502
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: NURSE NEXT DOOR
FACILITY NUMBER: 344700054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2024
Section Cited
1796.43
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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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Licensee removed all Home Care Aides (HCAs) from providing services to the public that did not have a cleared/eligible status prior to the complaint investigation and is in compliance.
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Home Care Aides (HCAs) were providing services to the public that did not have a cleared/eligible status. This poses an immediate health and safety risk to clients in care.
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Type A
05/14/2024
Section Cited
1796.23
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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...
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Licensee removed all Home Care Aides (HCAs) from providing services to the public that did not submit fingerprints prior to the complaint investigation and is in compliance.
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Home Care Aides (HCAs) were providing services to the public that did not submit fingerprints. This poses an immediate 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: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2