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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700686
Report Date: 07/30/2024
Date Signed: 07/30/2024 11:14:43 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/30/2024 11:14 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:W.A.Y.S. HOME CARE & HEALTH AGENCY, LLCFACILITY NUMBER:
194700686
ADMINISTRATOR/
DIRECTOR:		JOHNSON, KEDRINFACILITY TYPE:
300
ADDRESS:8617 CRENSHAW BLVDTELEPHONE:
(424) 702-5222
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: CENSUS: DATE:
07/30/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Kedrin JohnsonTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of W.A.Y.S. HOME CARE & HEALTH AGENCY, LLC on 7/30/24 for a biennial inspection. Upon arrival, the analyst identified himself and was greeted by licensee Kedrin Johnson. The proper posting of business hours and license was observed. 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.

Enforcement 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: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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 2
Document Has Been Signed on 07/30/2024 11:14 AM - It Cannot Be Edited


Created By: Ryan Chan On 07/30/2024 at 10:43 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: W.A.Y.S. HOME CARE & HEALTH AGENCY, LLC
FACILITY NUMBER: 194700686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/30/2024
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...”
This requirement was not met as evicenced by:
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Based on documents reviewed licensee failed to ensure that home care aides(S2, S3, and S5) are cleared on the home care aide registry before placing them with clients which poses an immediate risk to clients in care.
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Type A
07/30/2024
Section Cited
1796.45(d)
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1796.45(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease.
This requirement was not met as evidenced by:
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Based on documents reviewed licensee failed to keep a copy of home care aide's (S3) proof of TB test on file which poses an immediate 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: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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