Your IHSS Appeal
Action Plan
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 | 3:30 hrs | 10:11 hrs | +6:41 hrs | Reduced |
Bowel & Bladder Care |
5 | 0 hrs | 17:40 hrs | +17:40 hrs | Denied |
Ambulation |
4 | 4:00 hrs | 7:35 hrs | +3:35 hrs | Reduced |
| 5 | 0 hrs | 120:00 hrs | +120:00 hrs | Denied | |
Repositioning & Rubbing Skin |
4 | 2:00 hrs | 3:15 hrs | +1:15 hrs | Reduced |
Medication Management |
3 | 0 hrs | 2:02 hrs | +2:02 hrs | Denied |
Meal Preparation |
3 | 4:30 hrs | 15:09 hrs | +10:39 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 14:00 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 3:30 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 3:30 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
Date of Birth: August 14, 1942
County: Los Angeles
Notice of Action Date: May 28, 2026
Case Number: [Your IHSS Case Number]
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
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Physician letter addressing ALL disputed tasks — Ask Dr. Hernandez to write a letter specifically addressing Eleanor's functional limitations for each denied service, her inability to be left alone safely, and her total dependence for bowel/bladder care. The letter should use the words "totally dependent" and "substantial assistance" where applicable.Critical
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Incident log with dates and descriptions — Document every unsafe incident since the assessment. Include the March wandering incident (police report #LA-2026-0304-7842), the April gas incident, and the May fall (ER records). Dates, times, and specific descriptions carry significant weight at hearings.Critical
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Hospital and ER records — Cedars-Sinai ER visit May 2, 2026 and any prior hospitalizations related to Eleanor's condition.Critical
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Neuropsychological evaluation — Any cognitive assessment results documenting Eleanor's memory, executive function, and safety awareness deficits.High
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Sheriff's Department incident report — Report #LA-2026-0304-7842 from the March wandering incident. Contact the Sheriff's Department records unit to obtain a copy.High
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Current medication list — Full list of prescriptions with dosages, documenting why medication management assistance is required.High
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Written statements from family members or care providers — Anyone who regularly assists Eleanor can submit a written statement describing what they observe. Specific examples are more effective than general statements.Recommended
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This IHSSHours.com Appeal Package — Bring the full printed package to the hearing as a structured supporting document. The appeal narratives in Section 2 are written in CDSS-aligned language and may be read into the record.Recommended
Sources for this sample
- CDSS Hourly Task Guidelines — weekly time ranges by Functional Index rank, converted to monthly at 4.33 (MPP 30-763.2). The expected figures above are the floor of each published range
- WIC 12301.2, MPP 30-758 — time-per-task and frequency
- MPP 30-701(s)(1), WIC 12303.4 — “severely impaired” and the 283 / 195 hour monthly maximums. A total of 249 hours sits under the 283 ceiling that applies to a severely impaired recipient
- MPP 30-757.17 and 30-757.172 — Protective Supervision, and the five situations in which it cannot be authorized
- WIC 10951, MPP 22-009.1 — the 90-day window to request a State Hearing; good cause can extend it to 180 days
- MPP 22-072 — aid paid pending: within 10 days of the notice, or before the effective date of the action, whichever is later
- MPP 22-060 — a decision is due within 90 days of the filing date; WIC 10960(a) — 30 days to request a rehearing
These figures use the same Hourly Task Guideline numbers as the guide pages, checked against the CDSS IHSS Training Academy HTG Documentation Worksheet. Sample for illustration only. How we calculate estimates
