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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434700149
Report Date: 07/25/2023
Date Signed: 07/26/2023 01:23:50 PM

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
04/05/2022 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20220405120417
FACILITY NAME:FIRSTLIGHT HOME CARE OF SILICON VALLEYFACILITY NUMBER:
434700149
ADMINISTRATOR:LANDAU, JASON NFACILITY TYPE:
300
ADDRESS:1066 SARATOGA AVE SUITE 210TELEPHONE:
(650) 460-3817
CITY:SAN JOSESTATE: ZIP CODE:
95129
CAPACITY:CENSUS: DATE:
07/25/2023
UNANNOUNCEDTIME BEGAN:
12:30 AM
MET WITH:Molly JohnsonTIME COMPLETED:
01:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Home Care Organization is operating sub office as the main office.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/26/23, Associate Governmental Program Analyst (AGPA) Megan Vigil arrived at First Light Home Care, located at 1066 Saratoga Ave. Suite 210. San Jose, CA 95129 regarding the above complaint allegation.

AGPA Vigil met with Designee, Molly Johnson. The Organization operated a sub-office at the location of 2110 Omega Road, Ste C San Ramon 94583. The Department notified the Organization of the discrepancies and the corrections were made immediately to be in compliance with the Statute of Health and Safety Code.

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 Code. Article 2. Section 1796.17, are being cited.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
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-20220405120417
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: FIRSTLIGHT HOME CARE OF SILICON VALLEY
FACILITY NUMBER: 434700149
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2023
Section Cited
1796.17
1
2
3
4
5
6
7
1796.17 (a) Each home care organization shall be separately licensed. Nothing in this chapter shall prevent a licensee from obtaining more than one home care organization license or obtaining a home care organization license in addition to other licenses issued by the department, or both.
1
2
3
4
5
6
7
Designee, Molly Johnson, understands in order to operate a sub-office, would need to follow the regulations and fill out the form to apply for a sub-office license.
8
9
10
11
12
13
14
The Organization operated a sub-office for interviews of caregiver and clients without an approved license for the location. This poses a potential Health and Safety risk to person in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2