The following tasks were either denied entirely or authorized at a lower rank than your functional limitations support. Each disputed task is documented below with supporting rationale based on California's CDSS Hourly Task Guidelines.
| Task | Your Rank | County Auth. | Expected | Gap / Month | Status |
|---|---|---|---|---|---|
Bathing & Oral Hygiene |
4 | 3.5 hrs | 6.0 hrs | +2.5 hrs | Reduced |
Bowel & Bladder Care |
5 | 0 hrs | 14.0 hrs | +14.0 hrs | Denied |
Ambulation |
4 | 4.0 hrs | 8.0 hrs | +4.0 hrs | Reduced |
Protective Supervision |
5 | 0 hrs | 120.0 hrs | +120.0 hrs | Denied |
Repositioning & Rubbing Skin |
4 | 2.0 hrs | 6.5 hrs | +4.5 hrs | Reduced |
Medication Management |
3 | 0 hrs | 3.5 hrs | +3.5 hrs | Denied |
Meal Preparation |
3 | 4.5 hrs | 6.5 hrs | +2.0 hrs | Reduced |
Eleanor Vasquez has been diagnosed with Alzheimer's disease, moderate stage, as documented by her neurologist Dr. Hernandez at UCLA Medical Center (see attached records). As a result of this diagnosis, Eleanor is unable to recognize danger, is unable to call for help in an emergency, and cannot safely manage her behavior when left alone — all qualifying criteria for Protective Supervision under California Welfare & Institutions Code §12300(b) and CDSS policy.
Eleanor has exhibited the following documented unsafe behaviors when left without supervision: On March 4, 2026, Eleanor left the home at approximately 11:30 PM and was found by a neighbor two blocks away. She was disoriented and unable to identify her address. Los Angeles County Sheriff's Department was called (incident report #LA-2026-0304-7842 attached). On April 17, 2026, Eleanor turned on the gas stove and was unable to light it, leaving the gas on for an estimated 40 minutes before her daughter arrived. On May 2, 2026, Eleanor fell attempting to use the stairs unassisted, resulting in an emergency room visit at Cedars-Sinai (records attached).
The county's denial of Protective Supervision fails to account for these documented incidents and is inconsistent with CDSS guidelines, which recognize that a recipient who is both mentally impaired and nonself-directing may require a 24-hours-a-day protective component. The authorized IHSS hours shall reflect the hours Eleanor cannot safely be left alone that are not already covered by other authorized services.
Eleanor requires complete assistance with all aspects of bowel and bladder care due to urinary and fecal incontinence resulting from her Alzheimer's diagnosis. She is totally dependent (Rank 5) and cannot perform any component of this task independently. Eleanor is unaware when she needs toileting assistance and cannot communicate the need. The county's authorization of zero hours for this task is not supported by the CDSS Hourly Task Guidelines for a recipient with a Rank 5 dependency level.
Per California's official HTG, a Rank 5 dependency for Bowel & Bladder Care supports an authorization of approximately 14.0 hours per month. We request that the county reconsider this determination at the State Hearing.
Eleanor was assessed at Rank 4 (Substantial Assistance) for Bathing & Oral Hygiene, requiring hands-on physical assistance for all bathing and hygiene tasks. The county authorized 3.5 hours per month for this task. Per CDSS Hourly Task Guidelines, a Rank 4 dependency for Bathing & Oral Hygiene supports 6.0 authorized hours per month. The county's authorization of 3.5 hours appears to reflect an error in applying the HTG to Eleanor's assigned rank. We request correction to the full 6.0 hour authorization consistent with the assigned Rank 4 dependency level.
California Department of Social Services
State Hearings Division
P.O. Box 944243
Sacramento, CA 94244
RE: Request for State Hearing — IHSS Notice of Action
Dear State Hearings Division,
I am writing to formally request a State Hearing regarding the Notice of Action issued by the Los Angeles County Department of Public Social Services dated May 28, 2026, which reduced and denied certain In-Home Supportive Services for Eleanor Vasquez.
I dispute the county's determination on the following grounds:
1. Protective Supervision was denied in its entirety. Eleanor has a documented diagnosis of Alzheimer's disease (moderate stage) and has exhibited multiple unsafe behaviors when left alone, including wandering incidents, falls, and inability to recognize danger. The denial is inconsistent with CDSS eligibility criteria and applicable law.
2. Bowel & Bladder Care was denied (Rank 5). Eleanor is totally dependent for this task due to incontinence resulting from her Alzheimer's diagnosis. The county's authorization of zero hours is not consistent with the CDSS Hourly Task Guidelines for her assigned dependency level.
3. Multiple additional tasks were authorized at fewer hours than supported by the assigned Functional Index Rank. The authorized hours for Bathing, Ambulation, Repositioning, Medication Management, and Meal Preparation do not reflect the hours prescribed by the official HTG for Eleanor's assessed dependency ranks.
I request that this hearing be conducted at the earliest available date. I am also requesting that services continue at the previously authorized level while this appeal is pending (aid paid pending), as this request is made within 10 days of the Notice of Action date.
Please contact me at the address or phone number below to schedule the hearing.
Respectfully submitted,
Maria Vasquez
Daughter and Authorized Representative
123 Main Street, Los Angeles, CA 90001
(213) 555-0100 · maria.vasquez@email.com