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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700096
Report Date: 03/26/2025
Date Signed: 03/27/2025 09:02:11 AM

Document Has Been Signed on 03/27/2025 09:02 AM - 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:EMERALD CAREGIVING, LLCFACILITY NUMBER:
074700096
ADMINISTRATOR/
DIRECTOR:		SANDOVAL, MARIAFACILITY TYPE:
300
ADDRESS:2655 APPIAN WAYTELEPHONE:
(800) 821-5367
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY: CENSUS: DATE:
03/26/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Diana SandovalTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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Enforcement Analyst (EA), Megan Vigil, with the Home Care Services Branch (HCSB) conducted an onsite inspection. The EA met with Designee, Diana Sandoval

During the inspection, the EA observed the posting of the license, operating business, and verified insurance requirements.

During today’s visit, EA Vigil, found the HCO was not in compliance and deficiencies were cited. An exit interview was conducted, a copy of this report, staff records review report and the appeal rights were provided.
NAME OF LICENSING PROGRAM ANALYST: Megan Vigil
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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 2
Document Has Been Signed on 03/27/2025 09:02 AM - It Cannot Be Edited


Created By: Megan Vigil On 03/26/2025 at 10:17 AM
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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: EMERALD CAREGIVING, LLC
FACILITY NUMBER: 074700096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/02/2025
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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TB clearance was not documented in the
caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
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Type B
04/16/2025
Section Cited
1796.44
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(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training...
(b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, ...(b), an affiliated home care aide shall complete a minimum of five hours of annual training...
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A record of completion of the required training
hours and topics was not documented in the
caregiver’s personnel records that were reviewed by HCSB analyst. This poses a potential health and safety risk to clients 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: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
LIC809 (FAS) - (06/04)
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