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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 424700034
Report Date: 03/14/2024
Date Signed: 04/26/2024 11:21:20 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
12/12/2023 and conducted by Evaluator Ramsey Chimienti
COMPLAINT CONTROL NUMBER: 47-HC-20231212083857
FACILITY NAME:SUPERIOR SENIOR HOME CAREFACILITY NUMBER:
424700034
ADMINISTRATOR:MARTINEZ, PABLOFACILITY TYPE:
300
ADDRESS:320 E WALNUT AVETELEPHONE:
(805) 737-4357
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:CENSUS: DATE:
03/14/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Home Care Organization has a unregistered Home Care Aide working with clients before their background check has been cleared.
INVESTIGATION FINDINGS:
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On 3/14/24, Analyst Ramsey Chimienti arrived at the business address for Superior Senior Home Care. Analyst Chimienti introduced himself and was greeted by Pablo Martinez. Analyst explained that he was there to investigate the above complaint allegation. Analyst Chimienti interviewed Mr. Martinez regarding the company’s onboarding process for caregivers including background check and registration on the Home Care Aide (HCA) Registry. Analyst Chimienti also reviewed personnel files and payroll to ensure licensing requirements are met. The documentation demonstrated that certain Home Care Aide staff are working prior to clearance on the Home Care Aide Registry. The licensee acknowledged that caregivers had worked shifts prior to clearance on the Home Care Aide Registry.
Based on Analyst’s observations and interviews, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Article 7, Section 1796.43(a) is being cited on the attached LIC 9099D.
Analyst Chimienti concluded the visit with an exit interview and provided a copy of the HCS 9099 and 9099D investigation reports along with appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
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-20231212083857
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: SUPERIOR SENIOR HOME CARE
FACILITY NUMBER: 424700034
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2024
Section Cited
1796.43 (a)
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Health and Safety Code § 1796.43 (a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients. Proof of clearance on the Home Care Aide Registry was not present in five of the caregiver’s personnel record(s) that were reviewed by the analyst. This poses an immediate health and safety risk to clients in care.
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Scan proof of clearance and registration 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 Eligible-Clearance for the five previously indicated caregivers and email to Derek.Milleman@dss.ca.gov. Until proof of clearance and registration is provided, these caregivers must be immediately removed from shifts with clients. Licensee has already terminated the employee who is not eligible on the Home Care Aide Registry and will remove them from the organization’s roster.
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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: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2