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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374700203
Report Date: 02/12/2025
Date Signed: 02/12/2025 09:56:14 AM

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
01/29/2025 and conducted by Evaluator Adrian L Mangina
COMPLAINT CONTROL NUMBER: 47-HC-20250129102104
FACILITY NAME:UNI CARE AT HOMEFACILITY NUMBER:
374700203
ADMINISTRATOR:KESHAVARZI, ALBERTFACILITY TYPE:
300
ADDRESS:1510 S ESCONDIDO BLVD., #103TELEPHONE:
(800) 796-6912
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:CENSUS: DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Daisy HannaTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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HCO is not providing services to client as contracted
INVESTIGATION FINDINGS:
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On February 12, 2025, Home Care Services Branch (HCSB) Enforcement Analyst (EA) Adrian Mangina arrived at the business office of Uni Care at Home for the purpose of delivering the findings for the complaint received on 1/29/25. EA met with Designee Daisy Hanna.

It was alleged that Home Care Organization (HCO) is not providing services to client as contracted as there is no care plan provided. EA attempted to interview reporting party but was unsuccessful. EA interviewed staff of Home Care Organization who stated that all clients, whether referred from the Veteran's Associations or Private pay clients receive the same intake process which includes an in-home assessment with staff. That assessment is used to create a care plan that is accessible to the client and loved ones in a three-ring binder that is delivered to the home prior to the first caregiving shift. Additionally, loved ones and assigned caregivers are granted access to the care plan prior to the first caregiving shift through the App, Generations,

continued on page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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-20250129102104
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: UNI CARE AT HOME
FACILITY NUMBER: 374700203
VISIT DATE: 02/12/2025
NARRATIVE
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should the binder be misplaced or damaged. Staff provided blank copies of orientation training materials for staff as well as copies binder documents. Staff also provided care plan, intake form, and VA Referral Authorizations for client #1 and client #2. Based on Interviews conducted, and records reviewed, the complaint alleging that HCO is not providing services to client as contracted is found to be unsubstantiated. 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.

Exit interview conducted and a copy of this report and HCS9098 Appeal Rights was emailed to Designee, Daisy Hanna.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2