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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 564700047
Report Date: 08/23/2024
Date Signed: 08/26/2024 11:34:31 AM

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
07/24/2024 and conducted by Evaluator Joshua Rarela
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240724121959
FACILITY NAME:MELOS HOME CAREFACILITY NUMBER:
564700047
ADMINISTRATOR:EDWIN OYASANFACILITY TYPE:
300
ADDRESS:1051 QUASAR CTTELEPHONE:
(805) 267-6865
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:CENSUS: DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Edwin OyasanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Home Care Organization (HCO) is using Independent Contractors
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an onsite
inspection for the purpose of a Complaint Investigation. The EA met with Home Care Organization (HCO) administrator named above and discussed the allegation.

During the course of the investigation, EA reviewed all of the Home Care Aide (HCA) files and observed that multiple HCAs had an Independent affiliation in their HCA Registry record in the State of California HCA Registry database. The administrator also stated that an HCA in the roster was an Independent Contractor, and that he was unaware that he was unable to employ HCAs as Independent Contractors.

Based on the EA's observations, interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. An exit interview was conducted. A copy of the reports, deficiencies, and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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-20240724121959
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: MELOS HOME CARE
FACILITY NUMBER: 564700047
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/23/2024
Section Cited
1796.37(a)(5)
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Health and Safety Code § 1796.37 (a), (5) …requirements set forth in this chapter, including all of the following…Provides the department, upon request, with a complete list of its affiliated home care aides, and proof that each satisfies the requirements of Sections 1796.43, 1796.44, and 1796.45.
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Licensee will submit to the HCO Analyst, Stormy Yang, proof of conversion of all 1099 independent contractors to W2 Home Care Aides which includes: Registry on the Home Care Aide Registry, TB clearance, and documentation of required training. Please include your two most recent payroll reports, Quarterly DE9, and DE9C tax reporting forms. All documents must be submitted Stormy.Yang@dss.ca.gov by the POC due date of 9/23/2024.
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This requirement is not as evidenced by:

The administrator stated that he employs an Independent Contractor HCA. In addition, review of the HCA Registry website showed that other HCAs had Independent Affiliation.
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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: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
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