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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364700050
Report Date: 01/31/2024
Date Signed: 02/07/2024 03:11:07 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
05/11/2023 and conducted by Evaluator Michael Drake
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230511120606
FACILITY NAME:COCA INC. PERSONAL CARE SERVICESFACILITY NUMBER:
364700050
ADMINISTRATOR:KIMBERLY REICHMANNFACILITY TYPE:
300
ADDRESS:245 N. EUCLID AVENUETELEPHONE:
(909) 399-0888
CITY:UPLANDSTATE: ZIP CODE:
91786
CAPACITY:CENSUS: DATE:
01/31/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Charisse WilsonTIME COMPLETED:
12:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Working unregistered HCAs

Working 1099 employees
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/31/2024, at 12:00pm, Home Care Services Branch Analyst (HCSA), Mike Drake, conducted a complaint phone call with licensee, Charisse Wilson and disclosed the purpose of the call.

At 12:25pm, HCSA Drake reviewed records for HCA #1 and the record did not show fingerprint clearance or registration on the HCA Registry prior to providing home care services. Licensee confirmed the start date for HCA#1 was 02/2023 and stated the HCA was not registered and was working as a 1099 employee. She also stated that she has other 1099 employees.

Based on HCSA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Health and Safety Code are being cited on the attached 9099D.
Exit interview was conducted. Copies of the HCS 9099, HCS 9099D, and appeal rights provided. Licensee told to to sign and return 9099.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chong Vang
LICENSING EVALUATOR NAME: Michael Drake
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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-20230511120606
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: COCA INC. PERSONAL CARE SERVICES
FACILITY NUMBER: 364700050
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2024
Section Cited
1796.43(a)(1)
1
2
3
4
5
6
7
(a) 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...

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will remove all unregistered HCAs from providing home care services until those HCAs receive a background clearance, are registered on the Home Care Aide Registry and are associated to the HCO in Guardian. Provide HCO analyst updated roster by 02/07/2024.
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not ensure the HCA has fingerprinted clearance prior to providing home care services, which poses a potential health and safety risk to persons in care
8
9
10
11
12
13
14
Type A
02/07/2024
Section Cited
1796037(a)(5)
1
2
3
4
5
6
7
Health and Safety Code 1796.37(a)(5)... requirements set forth in this chapter including all of the following... Provides the department, upon request, with a complete list of its affiliated home care aides, and proof that each satisfies the requirements of Sections 1796.43, 1796.44, and 1796.45.
1
2
3
4
5
6
7
Licensee will submit to the HCO Analyst, Mike Drake, proof of conversion of all 1099 independent contractors to W2 Home Care Aides which includes: Registry on the Home Care Aide Registry, TB Clearance, Mandated Reporting, and documentation of required training. Please include your two most recent
8
9
10
11
12
13
14
Licensee utilized 1099 employees who are not registed to care for clients.
8
9
10
11
12
13
14
payroll reports, Quarterly DE9, and DE9C tax reporting forms. All forms must be submitted to Michael.Drake@dss.ca.gov by the POC due date of 02/07/2024.
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: Chong Vang
LICENSING EVALUATOR NAME: Michael Drake
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2