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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 494700041
Report Date: 09/11/2023
Date Signed: 09/11/2023 03:05:54 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
07/27/2023 and conducted by Evaluator Ramsey Chimienti
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230727072623
FACILITY NAME:FIJI PRIME IN-HOME CAREFACILITY NUMBER:
494700041
ADMINISTRATOR:NIQARA, SETAITAFACILITY TYPE:
300
ADDRESS:725 FARMERS LN STE 6TELEPHONE:
(707) 889-9505
CITY:SANTA ROSASTATE: ZIP CODE:
95405
CAPACITY:CENSUS: DATE:
09/11/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mareca Lolohea & Apenisa TabakauTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Home Care Aides not registered on the Home Care Aide Registry.
Working HCAs without the required amount of training.
INVESTIGATION FINDINGS:
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On 9/11/23, Analyst Ramsey Chimienti arrived at the business address for Fiji Prime In-Home Care. Analyst Chimienti introduced himself and was greeted by Mareca Lolohea & Apenisa Tabakau. Analyst explained that he was there to investigate the above complaint allegation. Analyst Chimienti reviewed administrative records pertaining to onboarding and training procedures. Analyst Chimienti also reviewed personnel files and payroll to ensure licensing requirements are met. The documentation demonstrated that HCA staff are working prior to clearance on the Home Care Aide Registry and the amount of training hours to meet licensing requirements was not documented within certain personnel records.
Based on AGPA'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. Article 7. Section 1796.43(a) and 1796.44 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 investigation report along with appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
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-20230727072623
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: FIJI PRIME IN-HOME CARE
FACILITY NUMBER: 494700041
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2023
Section Cited
1796.43
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Health and Safety Code § 1796.43 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. Staff NUMBERS did not have a clearance on the Home Care Aide registry. This poses an immediate health and safety risk to clients in care.
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Scan proof of clearance 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 HCSB@dss.ca.gov by 9/25/2023. Until proof of clearance and registration is provided, these caregivers must be immediately removed from shifts with clients.
Type A
10/11/2023
Section Cited
1796.44
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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.
(b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows:
(1) Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
(1) Clients’ rights and safety.
(2) How to provide for and respond to a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client.
(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through an online training program.
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Scan completed training logs for the previously indicated employees to HCSB@dss.ca.gov by 10/11/2023. Employees who have been identified as not yet having entry-level training must be removed from shifts with clients until documentation of completed training 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: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC9099 (FAS) - (06/04)
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