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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700589
Report Date: 12/20/2024
Date Signed: 12/20/2024 10:21:03 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/20/2024 10:21 AM - 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:JOSEPHINE HOME CAREFACILITY NUMBER:
194700589
ADMINISTRATOR/
DIRECTOR:		CHEYENNE CORONELFACILITY TYPE:
300
ADDRESS:539 E 213TH STTELEPHONE:
(562) 522-7355
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: CENSUS: DATE:
12/20/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Josephine Tortuya - LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Josephine Home Care on 12/20/24 for a biennial inspection. Upon arrival, EA identified himself and was greeted by licensee Josephine Tortuya. The proper posting of business hours and license was observed. 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 and advised that HCAs who do not have proof of negative TB testing completed every 2 years are not to be with clients. EA informed the licensee of the deficiencies found and explained they would be noted on the 809D.

EA 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: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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 12/20/2024 10:21 AM - It Cannot Be Edited


Created By: Ryan Chan On 12/20/2024 at 10:06 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: JOSEPHINE HOME CARE
FACILITY NUMBER: 194700589

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2024
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 that home care aide staff (S3) completed TB testing withing the required timeframe 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: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
LIC809 (FAS) - (06/04)
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