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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414700089
Report Date: 05/28/2025
Date Signed: 06/03/2025 07:11:29 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
05/05/2025 and conducted by Evaluator Ruben Perez
COMPLAINT CONTROL NUMBER: 47-HC-20250505150151
FACILITY NAME:FIRSTLIGHT HOME CARE OF THE PENINSULAFACILITY NUMBER:
414700089
ADMINISTRATOR:CARTERIS, JAMESFACILITY TYPE:
300
ADDRESS:1347 LAUREL ST.TELEPHONE:
(650) 486-1310
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:CENSUS: DATE:
05/28/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCO is not providing services to client as contracted.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 28, 2025, Enforcement Analyst (EA) Ruben Perez arrived at the business address for Firstlight Home Care Of The Peninsula. EA Perez introduced himself and was greeted by Ruby Salcedo. EA Perez explained that he was there to investigate the complaint allegation(s) referenced above. During the visit, EA Perez interviewed the designated representative regarding the company’s caregiver onboarding process, including procedures for conducting background checks and ensuring registration on the Home Care Aide (HCA) Registry. EA Perez also conducted a review of personnel files and payroll records to verify compliance with licensing requirements. EA Perez also received an APS report that was filed by the HCO regarding this concern. Additionally, EA Perez inquired about the company’s policies related to Home Care Aides failing to report for scheduled shifts. The designee was able to provide the following documentation:
• A Client Service Agreement, which outlines policies related to service interruptions,
• An Employee Handbook, which includes attendance and punctuality requirements set forth by the company.

Based on EA's observations and interviews, the EA concluded that there was not enough evidence to show that the organization violated the allegation(s) listed above, therefore, the above allegation(s) is found to be UNSUBSTANTIATED.

Analyst Perez concluded the visit with an exit interview and provided a copy of the HCS 9099 investigation report along with appeal rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
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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