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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700131
Report Date: 09/02/2025
Date Signed: 09/02/2025 11:26:41 AM

Document Has Been Signed on 09/02/2025 11:26 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:FIRSTLIGHT HOME CARE OF SOUTH BAYFACILITY NUMBER:
194700131
ADMINISTRATOR/
DIRECTOR:		ROBERTS, LARRYFACILITY TYPE:
300
ADDRESS:20710 MANHATTAN PL #104TELEPHONE:
(424) 704-5330
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: CENSUS: DATE:
09/02/2025
Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Salvador Morales Operations ManagerTIME VISIT/
INSPECTION COMPLETED:
11:45 PM
NARRATIVE
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Home Care Services Enforcement Analyst (EA), Ryan Chan created a case management report due to discovery from file review and interview with Operations Manager Salvador Morales that home care aide (HCA), S1, was not on the home care aide registry.

EA discussed the findings of the inspection with Mr. Morales and informed him of the deficiency found and explained they would be noted on the 809D. EA advised that all HCAs must be cleared in the home care aide registry prior to first presence with any client.

EA Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights to Mr.Morales.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2025
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 09/02/2025 11:26 AM - It Cannot Be Edited


Created By: Ryan Chan On 09/02/2025 at 11:10 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: FIRSTLIGHT HOME CARE OF SOUTH BAY
FACILITY NUMBER: 194700131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2025
Section Cited
1796.43 (a)
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1796.43 (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...”
This requirement is not met as evidenced by:
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Based on records reviewed and interviews conducted, licensee did not ensure home care aide (HCA) S1 was cleared on the home care aide registry before S1 was placed in direct contact with clients which poses an immediate risk to the health and safety of 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2025
LIC809 (FAS) - (06/04)
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