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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374700232
Report Date: 10/17/2023
Date Signed: 10/26/2023 09:09:57 AM

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
08/01/2023 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230801163104
FACILITY NAME:MANA HOME CARE, LLCFACILITY NUMBER:
374700232
ADMINISTRATOR:IGNACIO, BOBBYFACILITY TYPE:
300
ADDRESS:3186 VISTA WAY STE 309TELEPHONE:
(760) 455-8409
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:CENSUS: DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jolene IgnacioTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Home Care Aides are not registrered on the the Home Care Aide Registry.
INVESTIGATION FINDINGS:
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On 10/17/2023, Associate Governmental Program Analyst (AGPA) Megan Vigil arrived at, Mana Home Care LLC, located at 3186 Vista Wat STE 309, Oceanside, CA 92056, regarding the above complaint allegation.

AGPA Vigil met with Designee, Jolene Ignacio. AGPA Vigil conducted an initial inspection for record review and discrepancies were found.

Based on AGPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Health and Safety Code Articles are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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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Control Number 47-HC-20230801163104
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: MANA HOME CARE, LLC
FACILITY NUMBER: 374700232
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2023
Section Cited
1796.23
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....Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision...
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Scan proof of clearance in the form of a screen capture from the Home Care Aide Registry Search site or a copy of your current personnel roster in Guardian showing registered/eligible for all employees and email to Analyst by 10/31/23. Remove all Home Care Aides from providing services to the public immediately.
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Home Care Aides (HCA) are providing services to the public without an eligilbe status on the HCA registry. This poses an immediate Health and Safety risk to persons in care.
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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: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2