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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434700160
Report Date: 09/24/2024
Date Signed: 09/24/2024 04:31:34 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
08/30/2024 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240830125216
FACILITY NAME:SENIOR HELPERS SAN JOSEFACILITY NUMBER:
434700160
ADMINISTRATOR:YAJNIK, ALAYFACILITY TYPE:
300
ADDRESS:1262 E HAMILTON AVE #FTELEPHONE:
(408) 294-4411
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:CENSUS: DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ruth CervantesTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Home Care Aides are not registered on the Home Care Aide Registry.
Home Care Aides do not have a fingerprint clearance or exemption.
INVESTIGATION FINDINGS:
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Home Care Services Branch (HCSB) Analyst, Ramsey Chimienti, conducted a complaint investigation regarding the above allegations. Analyst Chimienti met with Designee, Ruth Cervantes. The analysts reviewed a list of documents that were compiled by Ruth in order to complete the investigation. The requested documents included payroll from August 2024 through current as well as personnel records.

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, Sections 1796.43(a) and 1796.23 (a) are being cited on the attached HCS 9099D report.

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: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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-20240830125216
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: SENIOR HELPERS SAN JOSE
FACILITY NUMBER: 434700160
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2024
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
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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 previously indicated caregivers and email to Karen.Ng@dss.ca.gov by 10/4/24. Until proof
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was not documented in four of the caregiver’s personnel records that were reviewed by the HCSB analyst. This poses an immediate health and safety risk to clients in care.
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of clearance and registration is provided, these caregivers must be immediately removed from shifts with clients.
Type A
10/04/2024
Section Cited
1796.23 (a)
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Health and Safety Code § 1796.23 (a) Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d). Criminal
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The licensee acknowledges that fingerprint clearance from the Department in the form of either a screen capture from the Home Care Aide Registry Search site, a copy of the registration/exemption approval letter from the Department, or a copy of the personnel roster from Guardian showing
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Background Clearance and/or Exemption approval was not obtained for one of the caregivers on staff. This poses an immediate health and safety risk to clients in care.
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“Eligible-Clearance” must be documented for all caregivers prior to contact with clients in order to satisfy this requirement. The licensee will produce a typed acknowledgement of this requirement and email to Karen.Ng@dss.ca.gov by 10/4/2024.
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: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2