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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700112
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:41:58 PM

Document Has Been Signed on 06/13/2024 01:41 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:1HEART CAREGIVER SERVICESFACILITY NUMBER:
194700112
ADMINISTRATOR/
DIRECTOR:		TAGARAO, KEVINFACILITY TYPE:
300
ADDRESS:16530 VENTURA BLVD STE 500TELEPHONE:
(818) 906-4441
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY: CENSUS: DATE:
06/13/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Kevin Tagarao, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst, Mila Quinto arrived at the business office of 1HEART CAREGIVER SERVICES for a biennial inspection. Upon arrival, Analyst Quinto was greeted by Designee, Belina Calderon-Nernberg and Rica Te. At 10:20am, Licensee, Kevin Tagarao arrived at the business office. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. The Analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review, the analyst discussed the findings of the inspection with designee. The Analyst informed the designee of the deficiency found and explained they would be noted on the 809D.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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 06/13/2024 01:41 PM - It Cannot Be Edited


Created By: Mila Quinto On 06/13/2024 at 12:32 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: 1HEART CAREGIVER SERVICES
FACILITY NUMBER: 194700112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2024
Section Cited
1976.44(a)
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1796.44 Training Requirements
(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements...
This requirement is not met as evidence by:
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Based on file review, 5 of 10 HCA files did not have the required hours of training. This posses a potential safety risk to children 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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