<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434700008
Report Date: 01/18/2024
Date Signed: 01/18/2024 12:25:43 PM

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
06/21/2023 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230621113155
FACILITY NAME:HOME HELPERS OF SANTA CLARA VALLEYFACILITY NUMBER:
434700008
ADMINISTRATOR:KETAN SHAHFACILITY TYPE:
300
ADDRESS:1155 MERIDIAN AVE, STE. 110TELEPHONE:
(408) 259-5930
CITY:SAN JOSESTATE: ZIP CODE:
94125
CAPACITY:CENSUS: DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ranjitha Rajachar / Ketan ShahTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Home Care Aides are providing medical services to clients.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/18/2024 analyst, Ramsey Chimienti, completed a licensing inspection and complaint investigation at the above Home Care Organization. Designee, Ranjitha Rajachar, assisted the analyst during the visit and provided various documentation upon request. Based on interviews and evidence collected, the Analyst concluded that there was not conclusive evidence to substantiate the above allegation. Additionally, personnel documentation that was reviewed demonstrated that HCA staff is being provided the required amount of training hours and education topics to meet licensing requirements. The analyst delivered the findings to both the Designee and Licensee. Based on the preponderance of evidence gathered through interviews conducted, evidence obtained and observations, the above allegations were found to be unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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 1