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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364700095
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:25:02 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
03/29/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20240329154355
FACILITY NAME:INDEPENDENCE ASSISTANCE INCFACILITY NUMBER:
364700095
ADMINISTRATOR:MONTIEL, YOLANDAFACILITY TYPE:
300
ADDRESS:278 TENNESSEE ST STE 3TELEPHONE:
(909) 798-2700
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:CENSUS: DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sharon Whiteside, LicenseeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
HCO does not ensure HCAs have a fingerprint clearance
HCO does not ensure HCAs have a tuberculosis clearance
INVESTIGATION FINDINGS:
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Home Care Services Branch Analyst, Mila Quinto conducted an investigation visit to Independence Assistance to deliver the complaint findings. Analyst met with Sharon Whiteside (licensee) and Andrew Ryan (designee).
The complainant alleged HCO does not ensure HCAs have fingerprint clearance and tuberculosis clearance.

On July 24, 2024, Analyst interviewed the licensee and designee. The licensee stated a previous employee handled updating the HCA requirements and is no longer working for the HCO. According to licensee, both the designee and licensee are working on all the HCA files to ensure all have the requirements on file. The designee stated took over reviewing the HCA files and discovered some with missing requirements and informed the licensee.
Analyst reviewed 14 HCA files. Based on file review, 8 HCA did not have criminal background clearance and 9 HCA did not have a current tb test clearance.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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 5
Control Number 47-HC-20240329154355
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: INDEPENDENCE ASSISTANCE INC
FACILITY NUMBER: 364700095
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2024
Section Cited
1796.23(a)
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1796.23 Fingerprint Requirements(a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints... in a manner approved by the department...
This requirement is not met as evidenced by:
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7
Analyst informed licensee all HCAs withuot cleared fingerprint should not provide service to clients.
Per Licensee and Designee will provide a written statement of plan of correction and submit to the analyst for the following HCAs: #1, #2, #3,#4, #5,#7, and #9 (See HCS859) by August 14, 2024
8
9
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14
Based on interview and file review on 7/24/24, 8 of the 14 HCAs did not have a cleared criminial background clearance.
This poses an immediate health and safety risk to the clients in care.
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9
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14
Type A
08/07/2024
Section Cited
1796.45(a)
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1796.45 TB Testing (a)Affiliated home care aides...shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
This requirement is not met as evidenced by:
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Analyst informed licensee all HCAs TB clearance should not provide service to clients.
Per Licensee and Designee will provide a written statement of plan of correction and submit to the analyst for the following HCAs:#1,#2,#3, #5,#7,#8, #9,#11,and #14 (See HCS859) by August 14, 2024.
8
9
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14
Based on interview and HCA file review on 7/24/2024, 9 of the 14 HCAs did not have a TB clearance.
This poses an immediate health and safety risk to the clients in care.
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9
10
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13
14
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: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 47-HC-20240329154355
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: INDEPENDENCE ASSISTANCE INC
FACILITY NUMBER: 364700095
VISIT DATE: 08/07/2024
NARRATIVE
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Page 2of 2

Based on interviews conducted and file review, the complaint alleging HCO does not ensure HCAs have fingerprint clearance and HCO does not ensure HCAs have a tuberculosis clearance has been SUBSTANTIATED. A substantiated finding means the allegation is valid due to the preponderance of the evidence standard has been met.

Health and safety code 1796.23(a) Fingerprint Requirements and 1796.45 TB Testing are being cited on the attached HCS 9099D. The 9099 and 9099D reports along with appeal rights were provided to the licensee, Sharon Whiteside.

A copy of this report and appeal rights was emailed to the licensee and designee
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/29/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20240329154355

FACILITY NAME:INDEPENDENCE ASSISTANCE INCFACILITY NUMBER:
364700095
ADMINISTRATOR:MONTIEL, YOLANDAFACILITY TYPE:
300
ADDRESS:278 TENNESSEE ST STE 3TELEPHONE:
(909) 798-2700
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:CENSUS: DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sharon Whiteside, LicenseeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCO does not ensure HCAs have completed the required training
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Home Care Services Branch Analyst, Mila Quinto conducted an investigation visit to Independence Assistance to deliver the complaint findings. Analyst met with Sharon Whiteside (licensee) and Andrew Ryan (designee).
The complainant alleged HCO does not ensure HCAs have completed the required training.

On July 24, 2024, Analyst interviewed the licensee and designee. The licensee stated a previous employee handled updating the HCA requirements and is no longer working for the HCO. According to licensee, both the designee and licensee are working on all the HCA files to ensure all have the requirements on file. The designee stated they use Care Academy for the annual required training which provides an auto notification reminder for each HCA due for the annual training.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 47-HC-20240329154355
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: INDEPENDENCE ASSISTANCE INC
FACILITY NUMBER: 364700095
VISIT DATE: 08/07/2024
NARRATIVE
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Page 2 of 2

Based on interviews and file review, the complaint alleging HCO does not ensure HCAs have completed the required training has been UNSUNSTATIATED. Although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

A copy of this report and appeal rights was emailed to the licensee and designee.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5