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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 564700080
Report Date: 08/07/2024
Date Signed: 09/04/2024 09:48:30 PM

Unsubstantiated


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
05/08/2024 and conducted by Evaluator Joshua Rarela
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240508093939
FACILITY NAME:FAMILY TIES HOME CARE LLCFACILITY NUMBER:
564700080
ADMINISTRATOR:CATHY BELSKYFACILITY TYPE:
300
ADDRESS:1350 LAFITTE DR.TELEPHONE:
(805) 917-6680
CITY:OAK PARKSTATE: CAZIP CODE:
91377
CAPACITY:CENSUS: DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Adam BelskyTIME COMPLETED:
03:29 PM
ALLEGATION(S):
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Home Care Aide is administering medications to clients
Home Care Aide is providing medical services to clients
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) representative named above and discussed the allegations.
During the course of the investigation, statements obtained from a former Home Care Aide (HCA) who allegedly provided medical services to clients indicated a denial of the allegations. The former HCA stated that they erroneously included in their resume that the HCO trained them with medication administration, and the HCA denied ever administering medications or providing medical services to home care clients at any time. The HCO also denied the allegations. The review of the HCA training records at the HCO indicated that HCAs are not trained on any medical services during their entry, annual trainings or duty statements.
Based on the EA's interviews, observations and records review, the allegations are unsubstantiated as the preponderance of evidence standard to prove the allegation was not met although the allegations may have happened or are valid. An exit interview was conducted. A copy of the reports and appeal rights were provided. This is an amended version of the original report created on 08/07/24.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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