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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364700065
Report Date: 12/18/2024
Date Signed: 12/18/2024 07:34:47 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
08/23/2024 and conducted by Evaluator Joshua Rarela
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240823120954
FACILITY NAME:LIVING ROOM - SENIOR HOME CARE, THEFACILITY NUMBER:
364700065
ADMINISTRATOR:DONNA MCCOINFACILITY TYPE:
300
ADDRESS:9828 VALLE VISTA ROADTELEPHONE:
(760) 983-5909
CITY:PHELANSTATE: CAZIP CODE:
92371
CAPACITY:CENSUS: DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sondra Cradduck, DirectorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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HCO did not provide services to client as contracted
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted a follow-up onsite inspection for the purpose of delivering the findings of a Complaint Investigation. The EA met with the HCO representative named above and discussed the allegation.

It was alleged that the HCO failed to provide services as contracted when a client was allegedly left unattended or without care periodically during the service duration. During the course of the investigation, EA conducted interviews and reviewed records including but not limited to client care and services agreement, client emergency information package and caregiver response time data from a client assistance call button device. The HCO denied the allegation of neglecting the care and service or failing to provide a contracted service at any point in time during the brief contract period of eight days with a previous client. The caregiver response time data taken from the call button device used by the client could not corroborate that the client was left unattended or without service from the HCO. (Continued, see HCS9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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-20240823120954
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: LIVING ROOM - SENIOR HOME CARE, THE
FACILITY NUMBER: 364700065
VISIT DATE: 12/18/2024
NARRATIVE
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(Continuation)

Based on the EA's observations, interviews and records review, there was insufficient evidence to prove the allegation as the preponderance of evidence standard was not met although the allegation may have happened or is valid, therefore the allegation is found to be unsubstantiated. An exit interview was conducted. A copy of this report was also provided.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2