[J United<\/p>\n
Private Caregiver Instructions<\/p>\n
and<\/p>\n
[J Third<\/p>\n
Checklist for Hiring<\/p>\n
Unit No.<\/p>\n
Laguna Woods Village<\/p>\n
The board of directors of United Laguna Woods Mutual and Third Laguna Hills Mutual adopted a<\/p>\n
Private Caregiver Policy to reasonably address caregivers who provide care for Residents. Every<\/p>\n
Private Caregiver Application for Permit must be approved in writing prior to commencing<\/p>\n
support. Please follow this checklist to ensure a smooth and efficient process.<\/p>\n
Omission of any required items will result in delay or denial of the Private Caregiver Permit.<\/p>\n
1<\/p>\n
Review the Private Caregiver Policy and submit the required paperwork.<\/p>\n
[J Register the Private Caregiver with the California Department of Social Services and<\/p>\n
complete the Live Scan requirements, which include background check and fingerprinting;<\/p>\n
[J Complete the Application for Private Caregiver Permit;<\/p>\n
[J Provide a copy of the private caregiver’s state-issued driver’s license or ID;<\/p>\n
[J Submit Private Caregiver Application to Community Services.<\/p>\n
2. Documentation Review<\/p>\n
The board of directors or authorized designee will review the submitted documentation for approval<\/p>\n
or denial. Community Services will notify the Resident of the outcome within 10 business days.<\/p>\n
a<\/p>\n
If approved, the private caregiver will be issued an ID, which must be worn in clear sight at<\/p>\n
all times and obtain a gate pass, which may include an overnight parking pass.<\/p>\n
b<\/p>\n
If denied, the Owner\/Member and private caregiver will be notified by Community Services.<\/p>\n
Important Information<\/p>\n
a<\/p>\n
All documents must be received by Community Services before the application can be processed;<\/p>\n
a<\/p>\n
The private caregiver cannot commence work until a permit is obtained. Special circumstances<\/p>\n
may be granted;<\/p>\n
a<\/p>\n
Only completed applications with the required paperwork will be reviewed;<\/p>\n
The private caregiver must be registered with the California Department of Social Services<\/p>\n
Home Care Services Bureau;<\/p>\n
The Private Caregiver Permit is approved for a period of up to one year and must be renewed<\/p>\n
annually;<\/p>\n
Community Services must be informed in writing of any deviations from an approved Private<\/p>\n
Caregiver Permit;<\/p>\n
a<\/p>\n
Owner\/Member is responsible for ensuring that rules, regulations and policies are followed by<\/p>\n
anyone he or she allows into the Community;<\/p>\n
a<\/p>\n
Failure to abide by the rules, regulations and policies may result in disciplinary action, including<\/p>\n
monetary fines, suspension of Owner\/Member privileges and\/or legal action.<\/p>\n
ATTACHMENTS<\/p>\n
Private Caregiver Policy<\/p>\n
Application for Permit<\/p>\n
Policy Frequently Asked Questions<\/p>\n
Private Caregiver \/ Home Care Aide Application Process<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 1 of 12
\n=<\/p>\n
Laguna Woods Village<\/p>\n
Private Caregiver Policy<\/p>\n
Purpose<\/p>\n
The purpose of this document is to define the policy of Third Laguna Hills Mutual (Third)<\/p>\n
and United Laguna Woods Mutual (United) regarding individuals who provide care to<\/p>\n
Residents.<\/p>\n
|]<\/p>\n
Definitions<\/p>\n
For the purposes of this policy:<\/p>\n
a<\/p>\n
Activities of Daily Living (ADL) are defined as a series of basic activities<\/p>\n
performed by individuals on a daily basis necessary for independent living at<\/p>\n
home or in the community. There are many variations on the definition of the<\/p>\n
activities of daily living, including, without limitation:<\/p>\n
1<\/p>\n
Personal hygiene: Bathing\/showering, grooming, nail care and oral care<\/p>\n
ll<\/p>\n
Dressing: The ability to make appropriate clothing decisions and physically<\/p>\n
dress\/undress oneself<\/p>\n
iii<\/p>\n
Eating: The ability to feed oneself, though not necessarily the capability to<\/p>\n
prepare food<\/p>\n
%<\/p>\n
Maintaining continence\/toileting: Both the mental and physical capacity to<\/p>\n
use a restroom, including the ability to get on and off the toilet and<\/p>\n
cleaning oneself<\/p>\n
Transferring\/Mobility\/Ambulating: Moving oneself from seated to standing,<\/p>\n
getting in and out of bed, and the ability to walk independently from one<\/p>\n
location to another<\/p>\n
b<\/p>\n
Instrumental ADL are not necessary for fundamental functioning, but they let an<\/p>\n
individual live independently in a Community.<\/p>\n
1<\/p>\n
Companionship and mental support<\/p>\n
ll<\/p>\n
Transportation and shopping<\/p>\n
iii<\/p>\n
Preparing meals<\/p>\n
Iv<\/p>\n
Managing household<\/p>\n
Managing medications and finances<\/p>\n
Vi.<\/p>\n
Communicating with others<\/p>\n
Application is the form prescribed by Third and United to apply for a private<\/p>\n
caregiver.<\/p>\n
Community is Laguna Woods Village.<\/p>\n
Community Facilities are defined as the facilities and services operated by the<\/p>\n
Golden Rain Foundation (GRF).<\/p>\n
Community rules are defined as the Bylaws, Articles of Incorporation, CC&Rs,<\/p>\n
Occupancy Agreement and any rules and regulations of Third, United, and GRF.<\/p>\n
9g<\/p>\n
GRF: The nonprofit mutual benefit corporation organized to manage and<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 2 of 12
\nmaintain Community Facilities and services for the Community.<\/p>\n
A live-in private caregiver is defined as an individual who will stay overnight for<\/p>\n
more than 60 days in any 12-month period, including individuals who are related<\/p>\n
to the Resident\/Member.<\/p>\n
A live-in private caregiver can be a family member, paid or not paid. All rules in<\/p>\n
the Private Caregiver Policy apply.<\/p>\n
Member is a person who has been approved by Third or United as being entitled<\/p>\n
under the governing documents of Third or United to membership in Third or<\/p>\n
United and has an appurtenant right of membership in GRF.<\/p>\n
Private caregiver, also known as a home care aide or care provider, is a person<\/p>\n
who has been approved by Third, United or authorized designee in writing on the<\/p>\n
basis of being a provider of primary caregiver support to the Resident. A private<\/p>\n
caregiver is a helper who assists an individual with activities of daily living or<\/p>\n
nonmedical services. Nonmedical home care is provided by caregivers. Unlike<\/p>\n
home health, caregivers are considered nonclinical and are not covered by<\/p>\n
insurance and does not need a physician order.<\/p>\n
Private caregiver services include, but are not limited to, assistance with the<\/p>\n
following:<\/p>\n
1<\/p>\n
ADL as defined in Section ll(a).<\/p>\n
ii. Instrumental ADL as defined in Section II(b).<\/p>\n
An affiliated caregiver is a person who is employed by a licensed Home Care<\/p>\n
Organization\/Agency (HCO) who provides homecare services to a Resident(s).<\/p>\n
A private caregiver is an independent Home Care Aide and is not employed by a<\/p>\n
HCO.<\/p>\n
In-home supportive service (IHSS) caregivers are part of the Medi-Cal program<\/p>\n
and are required to adhere to this policy.<\/p>\n
Resident is defined as any person who has been approved by the board of<\/p>\n
directors for occupancy.<\/p>\n
i.<\/p>\n
Conditions<\/p>\n
a<\/p>\n
Private caregivers must be approved by the board or authorized designee in<\/p>\n
writing prior to commencing support. Special circumstances may be granted.<\/p>\n
Private caregivers must be 18 years old or older.<\/p>\n
Private caregivers must be registered with the California Department of Social<\/p>\n
Services Home Care Services Bureau.<\/p>\n
Private caregivers must provide a copy of a driver’s license or passport with the<\/p>\n
application.<\/p>\n
Private caregivers must provide a copy of their driver’s license, vehicle<\/p>\n
registration, and proof of vehicle insurance with the application if he\/she will be<\/p>\n
operating a vehicle within Laguna Woods Village.<\/p>\n
A Private Caregiver Permit is approved for a period of up to one year. Residents<\/p>\n
are required to reapply for approval.<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 3 of 12
\nThe total number of persons residing in a unit shall not exceed the number of<\/p>\n
bedrooms, plus one or no more than two persons in a one-bedroom unit; no<\/p>\n
more than three persons in a two-bedroom unit, etc.<\/p>\n
Each private caregiver shall not have been convicted of a felony or a<\/p>\n
misdemeanor involving moral turpitude (e.g., fraud, perjury, criminal threats).<\/p>\n
The Member is responsible for the conduct of the private caregiver and shall<\/p>\n
ensure that he\/she complies with all community rules, regulations, and policies.<\/p>\n
Upon approval by the board or authorized designee, a gate pass shall be issued<\/p>\n
to the private caregiver that will permit gate access into the community. If a gate<\/p>\n
pass is supplied, it must be displayed on their car dashboard at all times. This<\/p>\n
pass may include an overnight parking pass when necessary.<\/p>\n
The private caregiver must wear in clear sight the Laguna Woods Village picture<\/p>\n
ID at all times.<\/p>\n
The private caregiver’s ID and gate pass may not be transferred or lent to<\/p>\n
anyone.<\/p>\n
The private caregiver is authorized to use the Community facilities only as<\/p>\n
necessarily incidental to provide support to the Resident.<\/p>\n
Part-time private caregivers may only use the laundry facilities for the Resident’s<\/p>\n
use. Live-in private caregivers may use the laundry facilities for their limited<\/p>\n
personal use and the Resident’s use.<\/p>\n
The live-in private caregiver requires written permission from the board of<\/p>\n
directors to remain in the unit without the Resident only if both of the following<\/p>\n
are applicable:<\/p>\n
1<\/p>\n
The Resident is absent from the unit due to hospitalization or other<\/p>\n
necessary medical treatment and expects to return to the unit within 90<\/p>\n
days from the date the absence began; and<\/p>\n
ll<\/p>\n
The Resident submits a written request to the board of directors desiring<\/p>\n
the live-in private caregiver be allowed to remain in order to be present<\/p>\n
when the Resident returns to reside in the unit ((Civil Code \u00a751.11(b)(7)).<\/p>\n
Private caregivers are not permitted to bring family members, pets or guests into<\/p>\n
the Community. The sole purpose of the private caregiver is to provide care for<\/p>\n
the Resident.<\/p>\n
The Resident must surrender the private caregiver ID and vehicle pass to<\/p>\n
Community Services at the conclusion of the care service or be subject to<\/p>\n
charges.<\/p>\n
The private caregiver shall meet all applicable GRF requirements relating to<\/p>\n
operating a motor vehicle within the community.<\/p>\n
All caregivers employed by a licensed Home Care Organization\/Agency (HCO)<\/p>\n
are required to obtain a business pass.<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 4 of 12
\nt<\/p>\n
A person living in the residence to provide short term care must obtain a 60-day<\/p>\n
caregiver pass. Any person providing care beyond 60 days must adhere to the<\/p>\n
Private Caregiver Policy.<\/p>\n
If applicant employs an IHSS caregiver and receives any correspondence related<\/p>\n
to ineligibility or violations that have occurred involving caregiver, the applicant<\/p>\n
must notify Community Services immediately.<\/p>\n
IV. Enforcement<\/p>\n
Third and United are authorized to take disciplinary action against a Member who is<\/p>\n
found in violation of the Private Caregiver Policy. When a violation occurs, the board of<\/p>\n
directors are obligated to evaluate and impose, if appropriate, Member discipline as set<\/p>\n
forth in the governing documents. The boards have the authority to impose monetary<\/p>\n
fines, suspend Member privileges, and\/or bring forth legal action. The Member is<\/p>\n
entirely responsible for ensuring that the community rules and policies are followed by<\/p>\n
anyone they allow into the Community.<\/p>\n
a<\/p>\n
The Member and private caregiver must read and agree to comply with and be<\/p>\n
bound by all the governing documents and the community rules.<\/p>\n
Nothing contained herein shall relieve Member of the performance of any<\/p>\n
obligation owed to Third, United and\/or GRF under the governing documents.<\/p>\n
V. Procedures<\/p>\n
a<\/p>\n
The Resident must complete and submit Application for Private Caregiver Permit<\/p>\n
for review. The application is available for download at lagunawoodsvillage.com<\/p>\n
or upon request from Community Services.<\/p>\n
Application can be submitted to Community Services located in the Laguna<\/p>\n
Woods Village Community Center.<\/p>\n
Upon receipt of an application, Community Services will research whether the<\/p>\n
Member and\/or private caregiver has received notices of violations or has any<\/p>\n
outstanding charges and assessments before approval of the application.<\/p>\n
The boards or authorized designee will review the application and approve or<\/p>\n
deny request.<\/p>\n
Community Services will notify the Resident of the results within 10 business<\/p>\n
days. Special circumstances may be granted.<\/p>\n
Community Services hours of operation are Monday through Friday, 8 a.m. to 5<\/p>\n
p.m., phone number 949-268-2393.<\/p>\n
Mailing address is P.O. Box 2220, Laguna Hills, CA 92654-2220.<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 5 of 12
\n[J United<\/p>\n
Pr<\/p>\n
Private Caregiver<\/p>\n
[J Third<\/p>\n
Laguna Woods Village<\/p>\n
Application for Permit<\/p>\n
Unit No.<\/p>\n
Return completed application to Community Services Department \u2014 240, 24351 El Toro<\/p>\n
Road, Laguna Woods, CA 92637; 949-268-2393; sally.munson@vmsinc.org<\/p>\n
Resident Information<\/p>\n
Name<\/p>\n
[J Member<\/p>\n
[J Occupant<\/p>\n
Address<\/p>\n
Telephone<\/p>\n
Cell phone<\/p>\n
Email<\/p>\n
What is the expected schedule of the private caregiver?<\/p>\n
[J Daytime only<\/p>\n
[J Nighttime only ~~ [[] 24 hours, number of days per week<\/p>\n
What is the service the private caregiver is expected to provide? Check all that apply.<\/p>\n
[J Personal hygiene (bathing)<\/p>\n
[J Companionship and mental support<\/p>\n
[J Continence management<\/p>\n
[] Transportation and shopping<\/p>\n
[J Dressing<\/p>\n
[] Preparing meals<\/p>\n
[J Feeding<\/p>\n
[J Managing household<\/p>\n
[J Ambulating<\/p>\n
[J Managing medications and finances<\/p>\n
[J Toileting<\/p>\n
[J Communicating with others<\/p>\n
[J Yes<\/p>\n
[1 No<\/p>\n
Is the Resident an in-home supportive services (IHSS) recipient?<\/p>\n
If Yes, list the seven-digit county IHSS case number<\/p>\n
Name<\/p>\n
Address<\/p>\n
Telephone<\/p>\n
Cell phone<\/p>\n
Email<\/p>\n
Driver’s license<\/p>\n
Expiration date<\/p>\n
Vehicle color<\/p>\n
Make<\/p>\n
Model<\/p>\n
License plate<\/p>\n
Vehicle insurance company<\/p>\n
Policy number, expiration date<\/p>\n
Private caregiver’s personal state identification number<\/p>\n
Expiration date<\/p>\n
[J Yes<\/p>\n
[J No<\/p>\n
Is the live-in private caregiver a family member?<\/p>\n
If yes, relationship to Resident<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 6 of 12
\nPrivate Caregiver Permit Agreement<\/p>\n
The undersigned acknowledges that the issuance of a private caregiver permit does not constitute<\/p>\n
approval of the private caregiver nor does it represent any direct or indirect liability on behalf of United<\/p>\n
Laguna Woods Mutual (United), Third Laguna Hills Mutual (Third) and the Golden Rain Foundation of<\/p>\n
Laguna Woods (GRF), all California nonprofit mutual benefit corporations, and Village Management<\/p>\n
Services Inc. (VMS), a California corporation, and each of their respective directors, officers,<\/p>\n
employees and agents. Further, I\/we have read and received a copy of the Private Caregiver Policy<\/p>\n
and agree to wear the ID in clear sight and display the pass at all times while in this Community. I\/we<\/p>\n
also understand that falsification of any information related to this application is subject to disciplinary<\/p>\n
action.<\/p>\n
*** Member is aware of and agrees to pay to the mutual an additional sum each month for each occupant<\/p>\n
of the unit in excess of two, at the rate prescribed by the mutual and GRF. A schedule of fees is available<\/p>\n
upon request and is subject to change annually. Additional fee is added to the member\u2019s account.<\/p>\n
Initial:<\/p>\n
Resident signature<\/p>\n
Date<\/p>\n
Member signature<\/p>\n
Date<\/p>\n
Date<\/p>\n
Private caregiver signature<\/p>\n
Received by<\/p>\n
SA No.<\/p>\n
Requirements [11D<\/p>\n
[J Gate pass<\/p>\n
[J Overnight pass<\/p>\n
[J Other<\/p>\n
Will approval cause the unit to exceed the number of occupants permitted? [1 Yes<\/p>\n
[J No<\/p>\n
State status of the private caregiver: [1 Pending [] Registered [] Other<\/p>\n
Has the Resident received notices of rules violation?<\/p>\n
[J Yes<\/p>\n
[J No<\/p>\n
[J Yes<\/p>\n
[J No<\/p>\n
Verified IHSS caregiver form SOC 2271<\/p>\n
Does staff recommend approval of this application?<\/p>\n
[J Yes<\/p>\n
[J No<\/p>\n
If, no, state reason<\/p>\n
Application DENIED<\/p>\n
Application APPROVED<\/p>\n
The Board of Directors of this mutual<\/p>\n
The Board of Directors of this mutual<\/p>\n
corporation or authorized designee has<\/p>\n
corporation or authorized designee has<\/p>\n
reviewed this application. Based on the<\/p>\n
reviewed this application. Based on the<\/p>\n
information provided, the application<\/p>\n
information provided, the application<\/p>\n
is denied.<\/p>\n
is approved.<\/p>\n
Signature<\/p>\n
Signature<\/p>\n
Signature<\/p>\n
Signature<\/p>\n
Signature<\/p>\n
Signature<\/p>\n
Resident notified by:<\/p>\n
Date<\/p>\n
[J Documents scanned<\/p>\n
[] SA No. updated\/closed<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 7 of 12
\nPrivate Caregiver<\/p>\n
Laguna Woods Village<\/p>\n
Policy Frequently Asked Questions<\/p>\n
Who is a private caregiver?<\/p>\n
A private caregiver also known as a home care aide or care provider, is a person who has<\/p>\n
been approved by Third Laguna Hills Mutual (Third), United Laguna Woods Mutual (United)<\/p>\n
or authorized designee in writing on the basis of being a provider of primary caregiver<\/p>\n
support to the Resident. Private caregiver services include, but are not limited to,<\/p>\n
assistance with the following:<\/p>\n
1<\/p>\n
Activities of Daily Living as defined in Section ll(a) of the Private Caregiver Policy.<\/p>\n
ii. Instrumental Activities of Daily Living as defined in Section II(b) of the Private<\/p>\n
Caregiver Policy<\/p>\n
What if my private caregiver is already registered with the California Department of<\/p>\n
Social Services (CDSS)?<\/p>\n
If your private caregiver is already registered with the CDSS, you will need to provide proof<\/p>\n
of registration, with expiration date, along with the completed Private Caregiver Application<\/p>\n
to Community Services.<\/p>\n
How does a Private Caregiver get registered with the CDSS?<\/p>\n
The Private Caregiver can apply as a Home Care Aide by visiting the CDSS website<\/p>\n
http:\/\/www.cdss.ca.gov:<\/p>\n
a. Click on Information & Resources at the top of the page<\/p>\n
b. Select Home Care Services listed under Community Care Licensing.<\/p>\n
c. Scroll down to Quick Links and select Home Care Aide Application Process.<\/p>\n
If you have questions, please phone California Department of Social Services, Home Care<\/p>\n
Service Bureau at 877-424-5778.<\/p>\n
How does a private caregiver get a background check?<\/p>\n
Complete the request for Live Scan fingerprinting service, form LIC 9163. Take form to a<\/p>\n
Live Scan location for processing. A criminal background check will be performed, and the<\/p>\n
results will be electronically sent to the CDSS.<\/p>\n
What are the costs to get registered?<\/p>\n
The CDSS currently charges a registration fee of $35. Other fees involved are Live Scan<\/p>\n
fingerprinting and government criminal history background checks. The Live Scan<\/p>\n
fingerprinting operator’s fee will vary depending on location of your choice and can run from<\/p>\n
$10 up to $49. Government fees for state and federal background checks for private<\/p>\n
caregivers will cost $49. Costs are subject to change.<\/p>\n
Who pays the registration costs?<\/p>\n
That is held to the Resident’s discretion. You can pay the private caregiver’s registration<\/p>\n
fees or require the private caregiver that you hire pay his\/her own registration fees.<\/p>\n
When did the mandate take place?<\/p>\n
The new policy began March 1, 2017.<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 8 of 12
\nPrivate Caregiver Policy<\/p>\n
Frequently Asked Questions Page<\/p>\n
20f2<\/p>\n
8<\/p>\n
Why do | have to obtain a Private Caregiver Permit?<\/p>\n
The board of directors of each mutual recognized a need to provide a systematic, fair and<\/p>\n
reasonable manner to address individuals who provide care to the residents.<\/p>\n
Who is expected to abide by the amended Private Caregiver Policy?<\/p>\n
All residents who hire a private caregiver must abide by the amended policy. Residents<\/p>\n
with existing private caregivers must abide by the amended policy when their current<\/p>\n
permit expires.<\/p>\n
10.How do I find out when my current permit is up for renewal?<\/p>\n
Call Community Services at 949-268-2393 or email sally.munson@vmsinc.org.<\/p>\n
11. Are there any exemptions or exceptions to the policy?<\/p>\n
There is no set list of exemptions. If there are special circumstances that the<\/p>\n
Owner\/Member would like to have taken into account, the Owner\/Member may file this<\/p>\n
request in writing to the board of directors stating why they cannot abide by the policy.<\/p>\n
This statement will be reviewed by the board for consideration.<\/p>\n
12. How can I file an exception\/exemption to the policy?<\/p>\n
Owner\/Members may file for an exception\/exemption by submitting a written request to<\/p>\n
Community Services located on the first floor of the Community Center.<\/p>\n
13. What if | hire a caregiver from a licensed agency?<\/p>\n
Caregivers from a licensed agency are exempt from this process because agencies are<\/p>\n
required by law to do background checks on all their caregivers. Agencies are required to<\/p>\n
obtain a business pass.<\/p>\n
14.Who is an in-home supportive services (IHSS) recipient?<\/p>\n
The IHSS program provides in-home assistance to eligible persons of 65 years of age and<\/p>\n
over, or disabled or blind individuals as an alternative to out-of-home care. The IHSS<\/p>\n
Program enables recipients to remain safely in their own homes.<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 9 of 12
\nTo Be Completed by Private Caregiver for State Registration<\/p>\n
Private Caregiver \/ Home Care Aide Application Process<\/p>\n
Revised August 21, 2023<\/p>\n
All private caregivers hired to work in Laguna Woods Village are required to register with the<\/p>\n
California Department of Social Services as a home care aide (HCA). Private caregivers can<\/p>\n
apply online or by mail. Applying online is the quickest way to obtain a personal ID. Applying<\/p>\n
by mail can take up to four weeks to process.<\/p>\n
Applicants can contact the Home Care Services Bureau at 877-424-5778 to check on the status<\/p>\n
of the application, or status can be obtained online at California Home Care Aide Registry<\/p>\n
(www.ccld.dss.ca.gov\/hcsregistry\/registrysearch.aspx). The Home Care Aide application fee is<\/p>\n
currently $35; and the registration is valid for two years and must be renewed to remain a<\/p>\n
Home Care Aide. The fee is subject to change.<\/p>\n
Private caregivers must also complete a request for Live Scan fingerprinting. A criminal<\/p>\n
background check will be performed, and results will be sent electronically to the California<\/p>\n
Department of Social Services Home Care Service Bureau. The Live Scan fingerprinting<\/p>\n
operator fee will vary depending on location of your choice and can range from $10 to $49.<\/p>\n
Costs are subject to change.<\/p>\n
To apply online for Home Care Aide registration, please have a credit card ready and follow<\/p>\n
the steps below:<\/p>\n
1. Access the Guardian Applicant Portal at https:\/\/quardian.dss.ca.gov\/Applicant.<\/p>\n
2. Create an account by clicking \u201cRegister as a new user.\u201d A temporary password will be sent to<\/p>\n
your email account. Your login username is your email address.<\/p>\n
3. Once a temporary password is received, log onto the Guardian and fill out the application.<\/p>\n
When prompted for a PIN (Personal Identification Number), enter R38XKSPE (the PIN for<\/p>\n
independent home care aides).<\/p>\n
You will be required to pay a fee of $35.00 to register; payment can be made by debit or credit<\/p>\n
card. At the end of the application process you will receive a Personal ID \/ HCA ID. This ID is<\/p>\n
required on the Laguna Woods Village Private Caregiver Application for Permit in the<\/p>\n
Private Caregiver Information section. It also allows you to access the Home Care Aide<\/p>\n
Registry to check status or for inquiries. It is important to always keep available.<\/p>\n
4. Print and complete the pre-populated Request for Live Scan Service LIC 9163 form and take<\/p>\n
it to an authorized Live Scan vendor to submit fingerprints and initiate the background<\/p>\n
check. In section 6 of the form, enter the Facility\/Organization No. 349855555 (this number<\/p>\n
represents the California Department of Social Services). For a list of approved Live Scan<\/p>\n
vendors in your area, please visit the California Department of Justice website.<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 10 of 12
\nFor questions regarding the application process in Guardian, please contact the Care Provider<\/p>\n
Management Bureau (CPMB) at 1-888-422-5669 or guardian@dss.ca.gov<\/p>\n
To apply via mail for Home Care Aide registration, please have a check or money order ready<\/p>\n
and complete the following steps:<\/p>\n
1<\/p>\n
Print and complete the following form:<\/p>\n
Application for Home Care Aide Registration or Renewal HCS 100 (also available<\/p>\n
in Spanish)<\/p>\n
Mail the completed application (HCS 100) and the $35.00 application fee (via check or<\/p>\n
money order) to the HCSB at:<\/p>\n
California Department of Social Services<\/p>\n
Home Care Services Bureau<\/p>\n
744 P Street, M.S. 9-14-90<\/p>\n
Sacramento, CA 95814<\/p>\n
Print and complete the Request for Live Scan Service LIC 9163 form and take it to an<\/p>\n
authorized Live Scan vendor to initiate the background check. In section 6 of the form,<\/p>\n
enter the Facility\/Organization No. 349855555 (this number represents the California<\/p>\n
Department of Social Services). For a list of approved Live Scan vendors in your area,<\/p>\n
please visit the California Department of Justice website.<\/p>\n
Applicants can contact the Home Care Services Bureau at 877-424-5778 to check on<\/p>\n
status of the application and to obtain their Personal ID\/HCA ID.<\/p>\n
A letter will be mailed to the applicant within four weeks of the post mark date with a status<\/p>\n
of their application.<\/p>\n
Home Care Aide Registration Renewal<\/p>\n
To renew your registration online, please have a credit card ready and follow the steps<\/p>\n
below:<\/p>\n
1. Access the Guardian Applicant Portal at https:\/\/quardian.dss.ca.gov\/Applicant.<\/p>\n
2. If you have not created an account before, please click \u201cRegister as a new user\u201d. Your login<\/p>\n
username is your email address. A temporary password was sent to the email account you<\/p>\n
used to register.<\/p>\n
3. Fill out Application. For \u201cRequest Type\u201d select \u201cHome Care Aide Registry Renewal\u201d.<\/p>\n
4. When prompted for a PIN, enter R38XKSPE (the PIN for independent home care aides).<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 11 of 12
\nYou will be required to pay a fee of $35.00 to renew your registration; payment can be made by<\/p>\n
debit or credit card.<\/p>\n
For questions regarding the renewal process in Guardian, please contact the Care Provider<\/p>\n
Management Bureau (CPMB) at 1-888-422-5669 or guardian@dss.ca.gov<\/p>\n
To renew via mail, please have a check or money order ready and complete the following<\/p>\n
steps:<\/p>\n
1<\/p>\n
Print and complete both pages of the following form:<\/p>\n
Application for Home Care Aide Registration or Renewal Form HCS 100, (also available<\/p>\n
in Spanish)<\/p>\n
2. Review the HCS 100 form for renewal application instructions.<\/p>\n
3. Mail the completed HCS 100 form and the $35.00 renewal fee (via check or money order)<\/p>\n
to the HCSB at:<\/p>\n
California Department of Social Services<\/p>\n
Home Care Services Bureau<\/p>\n
744 P Street, M.S. 9-14-90<\/p>\n
Sacramento, CA 95814<\/p>\n
Disclosure of HCA Personal Information<\/p>\n
For all registrations and renewals, the Department is required to provide the name and<\/p>\n
telephone numbers of Registered HCAs who do not opt-out of this requirement to labor<\/p>\n
organizations when the labor organization asks for the information. This means that if you do<\/p>\n
not opt-out of this requirement, your full name and any telephone numbers on file with the<\/p>\n
Department may be released to a labor organization.<\/p>\n
The law states that the labor organization can only use your information for employee<\/p>\n
organizing, representation, and assistance activities and it also states that the labor<\/p>\n
organization cannot disclose your information to any other party. However, the Department<\/p>\n
has no authority over labor organizations or control over what they do with the information.<\/p>\n
Additionally, if you opt-in at any point during your registration, there is a chance that your<\/p>\n
name and phone numbers may be provided to a labor organization and the Department<\/p>\n
cannot retract any personal information once it has been released to the labor organizations.<\/p>\n
For further information, see Health and Safety Code section 1796.29(d)-(f).<\/p>\n
Res 03-19-20 dated 02-19-19\/Res 01-19-32 dated 03-12-19<\/p>\n
Updated 12-29-2023<\/p>\n
Page 12 of 12<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","document_category":[1720],"document_type":[53],"class_list":["post-49497","document","type-document","status-publish","hentry","document_category-admin-services","document_type-other"],"acf":{"document":57156,"resolutions":null,"legacy_id":"8510","pdf_extracted_text":""},"yoast_head":"\n