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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700645
Report Date: 09/24/2024
Date Signed: 09/24/2024 03:42:25 PM

Document Has Been Signed on 09/24/2024 03:42 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:GENTLE SISTERS, LLC.FACILITY NUMBER:
194700645
ADMINISTRATOR/
DIRECTOR:		SHERALENE JORDANFACILITY TYPE:
300
ADDRESS:4371 CRENSHAW BLVD. #B1TELEPHONE:
(323) 596-3253
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY: CENSUS: DATE:
09/24/2024
Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Cheryl ThompsonTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 9/24/2024 Home Care Services Bureau (HCSB) Enforcement Analysts, Adrian Mangina and Mila Quinto arrived at the business office of Gentle Sisters LLC. Upon arrival, the Enforcement Analysts identified themselves and were granted entry by Licensee Cheryl Thompson. While at the premises EAs interviewed Licensee and learned that Licensee had forgotten to provide three files of current Home Care Aide files which were not reviewed as part of the required Biennial review on 9/10/24. Analysts Mangina and Quinto reviewed the files.

Upon completion of the file review the Analysts discussed the findings of the additional file review with the Licensee . The Analysts informed the representative named above that there were additional deficiencies which would be noted on the HCS809-D forms. Licensee was provided a copy of this report and the HCS9058 Appeal Rights form via email.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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 3
Document Has Been Signed on 09/24/2024 03:42 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 09/24/2024 at 01:33 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: GENTLE SISTERS, LLC.
FACILITY NUMBER: 194700645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2024
Section Cited
1796.45
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1796.45(a) TB Testing: Affiliated home care aides... 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.
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #1, #2, and #3 did not have TB test within 30 days before or 7 days after employment a finding which poses an immediate health and safety risk to persons in care.
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Type A
10/25/2024
Section Cited
1796.23(a)
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1796.23(a) Fingerprint Requirements: (a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d).
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This requirement was not met as evidenced by:
During the review of files, it was observed that Staff #1, #2, and #3 did not have fingerprint clearances, a finding 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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/24/2024 03:42 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 09/24/2024 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: GENTLE SISTERS, LLC.
FACILITY NUMBER: 194700645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/25/2024
Section Cited
1796.43(a)
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1796.43(a) Employees, Volunteers, and Affiliated Home Care Aide Requirements:(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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This requirement was not met as evidenced by:
During the review of files, it was observed that Staff #1, #2, and #3 are not affiliated with the HCO on the Home Care Aide Registry, a finding 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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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