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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804109
Report Date: 08/09/2023
Date Signed: 08/10/2023 08:36:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2023 and conducted by Evaluator Araceli Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20230807123007
FACILITY NAME:ALL QUALITY HOME CARE SERVICES, LLCFACILITY NUMBER:
486804109
ADMINISTRATOR:CARO, MARVINFACILITY TYPE:
735
ADDRESS:170 TERI CTTELEPHONE:
(510) 230-9897
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:4CENSUS: 0DATE:
08/09/2023
UNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Marvin Caro, AdministratorTIME COMPLETED:
04:57 PM
ALLEGATION(S):
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Care and Supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) A. Canela arrived unannounced for the purpose of opening the investigation of this complaint. LPA met with the Administrator and discussed the allegation. LPA toured the facility and took statements.
It was alleged that on 8/7/2023, outside agency arrived at the home and observed clients living in the home, with no staff to provide care and supervision. Based on statements received and although statement from Administrator, explained clients living in the home were independent and staff was checking in on them. Regulation 80078 requires facility Responsibility for Providing Care and Supervision. During todays inspection, LPA observed no clients living in the home and administrator explained they have moved out.

Continue report see LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
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 3
Control Number 21-AS-20230807123007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ALL QUALITY HOME CARE SERVICES, LLC
FACILITY NUMBER: 486804109
VISIT DATE: 08/09/2023
NARRATIVE
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The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20230807123007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ALL QUALITY HOME CARE SERVICES, LLC
FACILITY NUMBER: 486804109
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2023
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision as necessary to meet the client's needs.
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Facility to send in written statement they understand regulation and how they will ensure they are in compliance .
POC due date 8/10/2023
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***Based on statements received, this requirement has not been met as evidenced by: On 8/7/2023 clients living in the home were left with no staff to supervise them. This poses as an immediate risk to health and safety of clients in care.
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attention LPA Canela
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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: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3