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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 494700018
Report Date: 04/08/2025
Date Signed: 04/08/2025 01:21:26 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
02/19/2025 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250219140824
FACILITY NAME:HOME HELPERS OF SANTA ROSAFACILITY NUMBER:
494700018
ADMINISTRATOR:BANA SOLOMONFACILITY TYPE:
300
ADDRESS:703 2ND ST. STE. 306TELEPHONE:
(707) 867-1770
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:CENSUS: DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Rider NguyenTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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HCO is using unregistered home care aides to provide care to clients
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA), Ramsey Chimienti, with the Home Care Services Branch (HCSB) conducted an on-site inspection for the purpose of a complaint investigation. EA Chimienti arrived at the business address for Home Helpers of Santa Rosa, and was greeted by the TITLE, NAME. The analyst explained that he was there to conduct a complaint investigation regarding the above allegation and listed documents that will need to be made available in order to complete the investigation. The requested documents included payroll reports for January, February and March 2025, Quarterly DE9 Tax reporting document for the first quarter of 2025, and personnel files. Personnel files and interview conducted demonstrated an individual who worked shifts without being registered on the Home Care Aide Registry. Based on Analyst’s observations, interview, 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 1796.43(a) is 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: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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-20250219140824
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: HOME HELPERS OF SANTA ROSA
FACILITY NUMBER: 494700018
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2025
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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The Designee acknowledges that proof of clearance and registration in the form of a screen capture from the Home Care Aide Registry Search site or a registration/exemption approval letter from the Department must be kept on file for all caregivers prior to contact with clients...
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was not documented for one caregivers who worked shifts with client(s). This poses a potential health and safety risk to clients in care.
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The Designee will produce a typed acknowledgement of this requirement and email to Shelby.Whedon@dss.ca.gov by 4/16/25. Additionally, all current caregivers without registration clearance must be immediately removed from shifts with clients until proof of clearance is provided to the Department.
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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: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
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