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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344700061
Report Date: 01/25/2024
Date Signed: 04/25/2024 01:12:09 PM

Unsubstantiated


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
06/21/2023 and conducted by Evaluator Ramsey Chimienti
COMPLAINT CONTROL NUMBER: 47-HC-20230621140015
FACILITY NAME:PNV SENIOR CARE LLC DBA AMADA SENIOR CAREFACILITY NUMBER:
344700061
ADMINISTRATOR:CALDEIRA, JANIEFACILITY TYPE:
300
ADDRESS:13405 FOLSOM BLVD STE 700TELEPHONE:
(916) 801-4676
CITY:FOLSOMSTATE: ZIP CODE:
95630
CAPACITY:CENSUS: DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Naveen Vaid & Anjuli DeweesTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Home Care Organization is working unregistered home care aides.
Home Care Organization is working home care aides with below the required amount of training hours.
Home Care Organization is working home care aides with no or outdated TB testing.
INVESTIGATION FINDINGS:
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On 1/25/2024 Home Care Services Analysts (HCSAs), Ramsey Chimienti and Todd Borcher, conducted a complaint visit and met with Designee, Anjuli Dewees. Ms. Dewees assisted the HCSAs during the visit and provided various documentation upon request.
HCSAs Chimienti and Borcher reviewed personnel documentation including payroll and personnel files which demonstrated all Home Care Aides (HCAs) were cleared on the Home Care Aide Registry prior to working with clients, the documented training hours for HCAs met licensing requirements and HCAs had a current Tuberculosis clearance on file.

The Analysts concluded that there was not conclusive evidence to substantiate the above allegations. The analysts delivered the findings to both Naveen and Anjuli. Based on the preponderance of evidence gathered through interviews conducted, evidence obtained and observations, the above allegations were found to be unsubstantiated. An exit interview was conducted, and the licensing reports and appeal rights were provided to the licensee and designee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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