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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700079
Report Date: 08/28/2024
Date Signed: 08/30/2024 02:35:38 PM

Document Has Been Signed on 08/30/2024 02:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:GOOD CAREGIVER, THEFACILITY NUMBER:
074700079
ADMINISTRATOR/
DIRECTOR:		ONSTOTT, ALAYNEFACILITY TYPE:
300
ADDRESS:2129 PTARMIGAN DR. #2TELEPHONE:
(855) 210-2273
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY: CENSUS: DATE:
08/28/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Alayne OnscottTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office of The Good Caregiver for a required two year inspection.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Alayne Onscott. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of insurance's, personnel and administrative files could be performed. Upon completion of the file review, AGPA Vigil discussed the findings of the inspection with the Licensee and advised deficiencies were found. The deficiencies are noted on the 809D with a plan of corrections. A copy of the reports and appeal rights were provided to the Licensee.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 08/30/2024 02:35 PM - It Cannot Be Edited


Created By: Megan Vigil On 08/28/2024 at 01:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: GOOD CAREGIVER, THE
FACILITY NUMBER: 074700079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2024
Section Cited
1796.43
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..(a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients...
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Licensee scheduled HCA's who provided services to the public without a HCA registry. This poses an immediate Health and Safety risk to persons in care.
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Type A
09/13/2024
Section Cited
1796.23
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...(a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision...
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Licensee scheduled HCA's who provided services to the public without submitting fingerprints. This poses an immediate Health and Safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/30/2024 02:35 PM - It Cannot Be Edited


Created By: Megan Vigil On 08/28/2024 at 01:58 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: GOOD CAREGIVER, THE
FACILITY NUMBER: 074700079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2024
Section Cited
1796.45
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...(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease...
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Licensee scheduled HCA's who provided services to the public without a TB test. This poses an immediate Health and Safety risk to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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