564700090-5-14-2026-47-HC-SDUU-DUQUB6-20260604152545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 564700090
Report Date: 05/13/2026
Date Signed: 05/14/2026 01:13:26 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
04/22/2026 and conducted by Evaluator Joshua Rarela

PUBLIC

COMPLAINT CONTROL NUMBER: 47-HC-20260422092453

FACILITY NAME:	DIVINE AGAPE HEALTH CARE AGENCY		FACILITY NUMBER:	564700090
ADMINISTRATOR:	MARISOL MARTINEZ		FACILITY TYPE:	300
ADDRESS:	300 E. ESPLANADE DR STE 1720		TELEPHONE:	(805) 919-0071
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:		CENSUS:	DATE:	05/13/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Christine Bondoc		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Home Care Organization did not provide services to a client as contracted

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 the Home Care Organization (HCO)
representative named above.

During the course of the investigation, EA interviewed HCO personnel and reviewed Guardian Association History, Home Care Aide (HCA) Duty Statements, HCA Training History, Criminal Record Clearances, HCA Registry Database, and HCO Internal Incident Reports.

It was alleged that the Home Care Organization did not provide services to a client as contracted.

(CONTINUED)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

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-20260422092453

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: DIVINE AGAPE HEALTH CARE AGENCY	FACILITY NUMBER: 564700090
	VISIT DATE: 05/13/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The HCO staff reported that the client requested tasks exceeding the scope of contracted activities of daily living (ADL) services including requests for pet transportation to medical appointments. According to the HCO, approved transportation services only cover trips for groceries, medical appointments, and pharmacy pick-ups. According to the HCO, staff assisted the client during a temporary water shut-off by offering to transport her and her laundry to a local facility. This accommodation was met with client dissatisfaction, as the client maintained the expectation that staff would perform the laundry services directly. The HCO noted that performing independent laundry services under these circumstances exceeded the scope of their contracted care. Management emphasized that all clients are proactively educated on the specific operational limitations of the provided care.

The HCO acknowledged an incident where a caregiver failed to report an absence—of which management was previously unaware—subsequently prompting targeted staff retraining. Management clarified that standard protocols utilize a backup scheduling system to deploy alternative caregivers seamlessly, eliminating service disruptions. A review of the obtained documentation yielded insufficient evidence to confirm that the HCO committed intentional neglect or willful service omissions regarding the client.

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 and appeal rights were provided via electronic mail.

SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2