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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434700185
Report Date: 06/07/2024
Date Signed: 06/07/2024 01:13:52 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
03/29/2024 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240329101655
FACILITY NAME:AFFORDABLE SENIOR CAREFACILITY NUMBER:
434700185
ADMINISTRATOR:PATRICIA CUADROSFACILITY TYPE:
300
ADDRESS:286 E. HAMILTON AVE. #DTELEPHONE:
(408) 559-2810
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:CENSUS: DATE:
06/07/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Patricia CuadrosTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Home care aides do not have a fingerprint clearance
Home care aides do not have a tuberculosis (TB) clearance
Home care aides have not completed the required training hours
INVESTIGATION FINDINGS:
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Home Care Services Branch (HCSB) Analyst, Ramsey Chimienti, completed a follow-up complaint investigation visit regarding the above allegations. Analyst Chimienti spoke to Designee, Patricia Cuadros. In the course of the investigation, the analysts reviewed a list of documents that were previously made available by Ms Cuadros in order to complete the investigation. The requested documents included payroll, previous two Quarterly DE9 tax reports submitted by the company, a list of all active and inactive employees.
Based on Analyst’s observations, interviews and evidence collected, 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 1796.23 (a),1796.45(a), and 1796.44(a) are 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: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
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-20240329101655
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: AFFORDABLE SENIOR CARE
FACILITY NUMBER: 434700185
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2024
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 Background Clearance and/or Exemption approval was not obtained for several of the caregivers on staff. 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 all caregivers and email to Poyee.Vang@dss.ca.gov by 6/14/24. Until proof of clearance and registration is provided, these caregivers must be immediately removed from all shifts with clients.
Type A
06/14/2024
Section Cited
1796.45 (a)
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Health and Safety Code § 1796.45 (a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. TB clearance was not documented in several of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
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Scan completed TB clearance certifications for all Home Care Aides and email to poyee.vang@dss.ca.gov by 6/14/24. Until TB clearance is documented, these caregivers must be immediately removed from shifts with clients.
Type B
07/05/2024
Section Cited
1796.44 (a)
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Health and Safety Code § 1796.44 (a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
A record of completion of the required training hours and topics was not documented in several of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses a potential health and safety risk to clients in care.
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Scan completed training logs for all Home Care Aides and email to poyee.vang@dss.ca.gov by 7/5/24.
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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: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
LIC9099 (FAS) - (06/04)
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