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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374700014
Report Date: 10/18/2023
Date Signed: 10/18/2023 03:28:03 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
07/17/2023 and conducted by Evaluator Megan Vigil
COMPLAINT CONTROL NUMBER: 47-HC-20230717165612
FACILITY NAME:CANAAN HOME CAREFACILITY NUMBER:
374700014
ADMINISTRATOR:JENNIFER MARSHALLFACILITY TYPE:
300
ADDRESS:731 SOUTH HWY 101 SUITE 1K1TELEPHONE:
(858) 764-2663
CITY:SOLANA BEACHSTATE: CAZIP CODE:
92075
CAPACITY:CENSUS: DATE:
10/18/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Michell PetrovicTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Home care aides have expired TBclearances and are working with clients.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Associate Government Program Analyst (AGPA) Megan Vigil met with Designee, Michell Patrovic to discuss the above allegation.

AGPA Vigil completed a record review at the location of 731 S HWY 101 SUITE 1K1, Solana Beach, CA 92075 at approximately 1:45pm.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
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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