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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700304
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:40:36 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/14/2024 11:40 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:SENIORS IN-HOME CARE SERVICESFACILITY NUMBER:
194700304
ADMINISTRATOR/
DIRECTOR:		TIMOTHY NISBETFACILITY TYPE:
300
ADDRESS:5747 E. DEBORAH ST.TELEPHONE:
(562) 787-8585
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: CENSUS: DATE:
11/14/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Luzter Nisbet, HCO OwnerTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Seniors In-Home Care Services on 11/14/24 for a biennial inspection. Upon arrival, EA identified himself and met with licensee Luzter Nisbet. The proper posting of business hours and license was observed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with the licensee. EA informed the licensee of the deficiencies found and explained they would be noted on the 809D. Licensee was advised that home care aides without proof of clearance on the home care aide registry and without proof of current tb testing are not to be with clients.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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 11/14/2024 11:40 AM - It Cannot Be Edited


Created By: Ryan Chan On 11/14/2024 at 10:59 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

FACILITY NAME: SENIORS IN-HOME CARE SERVICES
FACILITY NUMBER: 194700304

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
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 licensee did not ensure that home care aide (S4, S8, and S9) were cleared on the home care aide registry before placing them in direct contact with clients which poses an immediate risk tto the health and safety of clients in care.
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Type A
11/15/2024
Section Cited
1796.45(a)
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1796.45 (a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
This requirement is not met as evidenced by:
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Based on records reviewed licensee did not ensure that home care aide (HCA) (S7) provided proof of negative tb within 90 prior to employment and up to 7 dys after employment to determine HCA is free from active tb which poses an immediate risk tto 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: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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