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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700368
Report Date: 01/07/2025
Date Signed: 01/07/2025 03:04:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/07/2025 03:04 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:AMITY IN-HOME CARE SERVICES, INC.FACILITY NUMBER:
194700368
ADMINISTRATOR/
DIRECTOR:		MA JOCYLINE P HANDELFACILITY TYPE:
300
ADDRESS:3535 LOMITA BLVD UNIT ATELEPHONE:
(310) 408-8608
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: CENSUS: DATE:
01/07/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Nancy Reyes - LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analysts (EA) Ryan Chan and Jane Cong-Huyen arrived at the business office of Amity In-Home Care Services on 1/7/2025 for a biennial inspection. Upon arrival, EAs identified themselves and were greeted by Nancy Reyes, licensee. The proper posting of business hours and license was observed. EAs were then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EAs discussed the findings of the inspection with the licensee, Nancy Reyes. EAs informed Ms. Reyes of the deficiencies found and explained they would be noted on the 809D page of the report.

EA Chan and Cong-Huyen concluded the visit with an exit interview and provided a copy of this report along with appeal rights via email.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/07/2025 03:04 PM - It Cannot Be Edited


Created By: Ryan Chan On 01/07/2025 at 01:31 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: AMITY IN-HOME CARE SERVICES, INC.
FACILITY NUMBER: 194700368

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/08/2025
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 record reviews and interviews. Licensee did not ensure that home care aides (HCA) staff (S2 & S10) were cleared on the home care registry before placing them with clients which poses an immediate risk to the health and safety of clients in care.
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Type A
01/08/2025
Section Cited
1796.45
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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 the record reviews and interviews. Licensee did not ensure home care aides (HCA) staff (S7, S8 & S9) did not have proof for TB prior to placing HCA with clients which poses an immediate risk to the health & 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: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/07/2025 03:04 PM - It Cannot Be Edited


Created By: Ryan Chan On 01/07/2025 at 02:02 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: AMITY IN-HOME CARE SERVICES, INC.
FACILITY NUMBER: 194700368

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2025
Section Cited
1796.44 (a)
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1796.44 (a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section. This requirement is not met as evidenced by:
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Based on record reviews and interviews. Licensee did not ensure that home care aides (HCA) staff (S4, S5, S7, S8, S9 & S10) completed required trainings for home care aides prior to being placed with clients which poses a potential 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: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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