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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434700108
Report Date: 05/15/2024
Date Signed: 05/15/2024 09:14:36 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
04/23/2024 and conducted by Evaluator Ramsey Chimienti
COMPLAINT CONTROL NUMBER: 47-HC-20240423080849
FACILITY NAME:SUPREME COMPANIONSFACILITY NUMBER:
434700108
ADMINISTRATOR:CRYSTAL GAYLE GALANGFACILITY TYPE:
300
ADDRESS:830 STEWART DR. STE 221TELEPHONE:
(408) 768-5049
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY:CENSUS: DATE:
05/15/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marlon GalangTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Home Care Aide(s) do not have a fingerprint clearance or exemption.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Home Care Services Branch (HCSB) Analyst, Ramsey Chimienti, completed a follow-up complaint investigation via phone/email regarding the above allegation. Analyst Chimienti spoke to Licensee, Marlon Galang. The analyst explained that he was finalizing a complaint investigation regarding the above complaint.

The analysts reviewed a list of documents that were previously made available by Mr. Galang in order to complete the investigation. The requested documents included payroll, previous two Quarterly DE9 tax reports submitted by the company, last six weeks of payroll reports, a list of all W2 employees.

Based on the preponderance of evidence gathered through interviews conducted, evidence obtained and observations, the above allegation was found to be UNSUBSTANTIATED. An exit interview was conducted via phone, and the licensing reports as well as the appeal rights documents were provided to the Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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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