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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700112
Report Date: 07/22/2025
Date Signed: 07/28/2025 11:09:31 AM

Document Has Been Signed on 07/28/2025 11:09 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:GOLDEN HEART WALNUT CREEKFACILITY NUMBER:
074700112
ADMINISTRATOR/
DIRECTOR:		SCHAUFLER, MICHAELFACILITY TYPE:
300
ADDRESS:150 N WIGET LN STE 112TELEPHONE:
(925) 203-3039
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: CENSUS: DATE:
07/22/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Michael SchauflerTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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 the Licensee Michael Schaufler

During the inspection, the EA verified the posting of the license, observed the operation of the business, and confirmed compliance with insurance requirements.

During the visit, EA Vigil determined that the Home Care Organization (HCO) was not in compliance with applicable sections of Health and Safety Code deficiencies were cited. An exit interview was conducted, and copies of this report, the staff records review report, and information regarding appeal rights were provided to the licensee/designee.
NAME OF LICENSING PROGRAM ANALYST: Megan Vigil
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 07/28/2025 11:09 AM - It Cannot Be Edited


Created By: Megan Vigil On 07/22/2025 at 12:33 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
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: GOLDEN HEART WALNUT CREEK
FACILITY NUMBER: 074700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2025
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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The Home Care Organization (HCO) did not have tuberculosis (TB) test record on file for its Home Care Aide (HCA). This poses an immediate 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: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
LIC809 (FAS) - (06/04)
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