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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394700004
Report Date: 03/28/2024
Date Signed: 03/28/2024 11:09:56 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
02/28/2024 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240228114955
FACILITY NAME:J&M HOMECARE SERVICES, LLCFACILITY NUMBER:
394700004
ADMINISTRATOR:VINING E. JENSENFACILITY TYPE:
300
ADDRESS:3453 BROOKSIDE ROAD, STE CTELEPHONE:
(925) 552-6500
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:CENSUS: DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Karon Lasley TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Home Care Aides are providing medical services to clients.
INVESTIGATION FINDINGS:
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Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of J&M Homecare Services LLC to discuss the above complaint allegation.

AGPA Vigil was greeted by Care Manager, Karon Lasley. Lasley admitted homecare aides did provide services including colostomy/catheter care and monitoring/recording blood pressure. The services are not specified in Health and Safety Code section 1796.12, subdivision (n).

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 deficiencies cited on the attached reports, appeal rights provided and exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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-20240228114955
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: J&M HOMECARE SERVICES, LLC
FACILITY NUMBER: 394700004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2024
Section Cited
1796.12 (n)
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“Home care services” means nonmedical services and assistance provided by a registered home care aide to a client...This subdivision shall not authorize a registered home care aide to assist with medication ...otherwise require administration or oversight by a licensed health care professional.
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Licensee, Designee, Employees, and Homecare Aides must review the Home Care Services Fact Sheet. Scan a copy of the document signed under penalty of perjury and email to margo.chipan@dss.ca.gov by 4.4.2024.

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Homecare aides provided medical services that are not allowed. This poses an immediate Health and Safety risk to persons in care.
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All homecare aides must stop any services that are not allowed to clients, effective as of 3.28.24.
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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: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
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