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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700318
Report Date: 09/18/2025
Date Signed: 09/18/2025 07:27:56 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/18/2025 07:27 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:SINCERE CARE SERVICESFACILITY NUMBER:
194700318
ADMINISTRATOR/
DIRECTOR:		FENG PEI QINFACILITY TYPE:
300
ADDRESS:747 N. LAKE AVE, STE. DTELEPHONE:
(626) 398-2098
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: CENSUS: DATE:
09/18/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Hugh Hongwei He - LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Sincere Care Services on 9/18/25 for a biennial inspection, EA met with licensee Hugh Hongwei He. The proper posting of business hours and license was observed. The proof of insurance records were reviewed. 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 and informed him of the deficiencies found and explained they would be noted on the 809D. EA advised that homecare aides who do not have proof of negative tb test within 2 years 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.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
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 09/18/2025 07:27 PM - It Cannot Be Edited


Created By: Ryan Chan On 09/18/2025 at 03:26 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: SINCERE CARE SERVICES
FACILITY NUMBER: 194700318

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2025
Section Cited
1796.45(c)
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1796.45(c) After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection shall be required to undergo an examination at least once every two years...required.

This requirement is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aides (HCA) S2 and S3 completed tb test every 2 years as required 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: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
LIC809 (FAS) - (06/04)
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