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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 564700080
Report Date: 05/09/2025
Date Signed: 05/09/2025 10:57:46 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
04/16/2025 and conducted by Evaluator Joshua Rarela
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250416105000
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:
05/09/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adam BelskyTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Home Care Aide provided 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 allegation.

During the course of the investigation, the EA interviewed the complainant, a former Home Care Aide (HCA) and HCO personnel along with reviewing records such as the HCA's work resume, the former HCA's training records and description of work duties with the HCO. The former HCA denied providing medical services to clients when she was a caregiver for the HCO. The former HCA stated that the HCO was clear to all of their HCAs that medical services cannot be provided to clients. The former HCA included in their work resume that they provided oxygen and medication administration to clients, but the former HCA stated that they should have reworded their resume to explicitly state that they only reminded the clients to take them.

(CONTINUED)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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-20250416105000
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: FAMILY TIES HOME CARE LLC
FACILITY NUMBER: 564700080
VISIT DATE: 05/09/2025
NARRATIVE
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The HCO also denied the allegation of allowing their HCAs to provide medical services to clients. The review of the former HCA's training records indicated that HCAs are not trained on any medical services during their entry and annual training; the former HCA's description of work duties for the HCO did not include any medical services provided to clients and were only non-medical related tasks.

Based on the EA's observations, interviews and records review, there was insufficient evidence to prove the allegation as the preponderance of evidence standard was not met although the allegation may have happened or is valid, therefore the allegation is found to be unsubstantiated. A copy of this report was provided via electronic mail.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2