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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700485
Report Date: 07/09/2025
Date Signed: 07/09/2025 12:47:25 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/09/2025 12:47 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:BELLE HOME CARE, INC.FACILITY NUMBER:
194700485
ADMINISTRATOR/
DIRECTOR:		BENILDA DELA CRUZFACILITY TYPE:
300
ADDRESS:1055 E. COLORADO BLVD. STE 500TELEPHONE:
(626) 297-8520
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY: CENSUS: DATE:
07/09/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Benilda DeLa Cruz - LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Belle Home Care Inc on 7/9/25 for a biennial inspection, EA met with licensee Benilda DeLa Cruz. 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. EA informed the licensee of the deficiencies found and explained they would be noted on the 809D. Licensee was advised that home care aides who don't have proof of negative tuberculosis test 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: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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 07/09/2025 12:47 PM - It Cannot Be Edited


Created By: Ryan Chan On 07/09/2025 at 12:01 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: BELLE HOME CARE, INC.
FACILITY NUMBER: 194700485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2025
Section Cited
1796.45(a)
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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 records reviewed licensee did not ensure home care aide (S1) had proof of negative tuberculosis prior to placement with clients 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: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
LIC809 (FAS) - (06/04)
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