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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700441
Report Date: 12/11/2024
Date Signed: 12/11/2024 03:31:53 PM

Document Has Been Signed on 12/11/2024 03:31 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:VISITING ANGELS OF CERRITOSFACILITY NUMBER:
194700441
ADMINISTRATOR/
DIRECTOR:		SYEEDA N. ASIEDUFACILITY TYPE:
300
ADDRESS:18000 STUDEBAKER RD, SUITE 700TELEPHONE:
(562) 474-8000
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: CENSUS: DATE:
12/11/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Kwasi Asiedu, designeeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a biennial visit. The EA met with designee, Kwasi Asiedu. The EA observed the posting of the license and operating business hours. Business operating hours are from 9am-4pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee, staff and Home Care Aides including fingerprint status', registry status', Tuberculosis (TB), and required training. The HCO’s business records were also reviewed during the visit.

Based on the file review, EA informed the designee of the deficiencies found and explained they would be noted on the 809D.

EA provided a copy of the report and appeal rights to the licensee via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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 12/11/2024 03:31 PM - It Cannot Be Edited


Created By: Mila Quinto On 12/11/2024 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: VISITING ANGELS OF CERRITOS
FACILITY NUMBER: 194700441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2024
Section Cited
1796.44(c)
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Training Requirements 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 t relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
(1) Clients’ rights and safety.
(2) How to provide for, and respond to, a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client.
(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through an online training program.
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This requirement is not met as evidenced by: The 4 of 5 files reviewed did not have the required training hours of the 5 hours per year.
This poses a potential safety risk to clients in care.
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Type B
12/19/2024
Section Cited
1796.52(c)
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1796.52(c) An investigation or inspection conducted by the department pursuant to this chapter may include, but is not limited to, inspection of the books, records, or premises of a home care organization.
This requirement is not met as evidenced by:
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According to the licensee, some files are kept electronically as EA was only able to review 5 of 20 active HCAs. Licensee stated she is not availble durng the visit to provide the electronic files.
This poses a potential safety risk to the 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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