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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700432
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:29:09 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/13/2024 03:29 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:FILIPINO AMERICAN PERSONAL HEALTH CARE SERVICESFACILITY NUMBER:
194700432
ADMINISTRATOR/
DIRECTOR:		RANDALL AND MARILOU FROSTFACILITY TYPE:
300
ADDRESS:8671 WILSHIRE BLVD. STE 709TELEPHONE:
(323) 537-5733
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90211
CAPACITY: CENSUS: DATE:
06/13/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Marilou FrostTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst Ryan Chan arrived at the business office of Filipino American Personal Health Care Services on 6/13/24 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by licensee Marilou Frost. The proper posting of business hours and license was observed. Licensee has changed her business hours, analyst advised to complete form HCS 200 and send to her analyst to update the record. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with the licensee. The analyst informed the licensee of the deficiencies found and explained they would be noted on the 809D.

Analyst Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights.
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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 4
Document Has Been Signed on 06/13/2024 03:29 PM - It Cannot Be Edited


Created By: Ryan Chan On 06/13/2024 at 02:09 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: FILIPINO AMERICAN PERSONAL HEALTH CARE SERVICES
FACILITY NUMBER: 194700432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
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...
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Based on documents reviewed, licensee did not ensure that home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients, S3 and S4 did not renew their registry. This poses an immediate health and safety risk to clients in care.
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Type A
06/13/2024
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...positive test...followed by an X-ray, the examination is no longer required.
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Based on documents reviewed, licensee did not ensure that home care aides had tb test redone after 2 years of initial tb test, S3 needs tb test. This poses an immediate health and safety risk to 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: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/13/2024 03:29 PM - It Cannot Be Edited


Created By: Ryan Chan On 06/13/2024 at 02:29 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: FILIPINO AMERICAN PERSONAL HEALTH CARE SERVICES
FACILITY NUMBER: 194700432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2024
Section Cited
1796.44 (c)
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1796.44 (c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific...
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Based on documents reviewed, licensee did not ensure that home care aides completed annual traing, S3 and S4 need proof of completion of annual training. This poses a potential health and safety risk to 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: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/13/2024 03:29 PM - It Cannot Be Edited


Created By: Ryan Chan On 06/13/2024 at 02:39 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: FILIPINO AMERICAN PERSONAL HEALTH CARE SERVICES
FACILITY NUMBER: 194700432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
1796.42 (b)
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1796.42 (a) A home care organization licensee shall do all of the following:
(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides.
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Based on documents reviewed, licensee did not have worker's compensation insurance. This poses an immediate risk to HCAs.
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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: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4