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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700401
Report Date: 11/22/2024
Date Signed: 11/22/2024 10:47:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/22/2024 10:47 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:VALLEYSTAR INC, DBA BRIGHTSTAR CAREFACILITY NUMBER:
194700401
ADMINISTRATOR/
DIRECTOR:		JOHN MASONFACILITY TYPE:
300
ADDRESS:5900 SEPULVEDA BLVD STE 515TELEPHONE:
(818) 528-5388
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: CENSUS: DATE:
11/22/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Rennier PerezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Biennial visit. The EA met with Home Care Organization (HCO) representative named above.

During the inspection, the EA observed the posting of the license and operating business hours which show the business operates from Monday through Friday, 8AM-5PM. EA reviewed the personnel records for licensee, staff and Home Care Aides. Furthermore, EA reviewed the HCO’s business records including training agenda, abuse reporting incidents, current designee and insurance requirements.

During today’s visit, EA informed the licensee of the deficiencies found and explained they would be noted on the HCS809-D.
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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 11/22/2024 10:47 PM - It Cannot Be Edited


Created By: Joshua Rarela On 11/22/2024 at 11:53 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: VALLEYSTAR INC, DBA BRIGHTSTAR CARE
FACILITY NUMBER: 194700401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/29/2024
Section Cited
1796.43
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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 review, it was observed that HCAs did not have an active HCA registry in the HCA Registry database, which poses an immediate Health and Safety risk to persons in care.
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Type A
11/29/2024
Section Cited
1796.45
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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...(d) an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease.
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This requirement is not met as evidenced by:

Based on records review, it was observed that HCAs did not have an updated TB test results, which poses an immediate Health and Safety risk to persons 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: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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