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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700867
Report Date: 09/20/2024
Date Signed: 09/20/2024 10:52:31 AM

Document Has Been Signed on 09/20/2024 10:52 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:AMIABLE HOMECARE INCORPORATEDFACILITY NUMBER:
194700867
ADMINISTRATOR/
DIRECTOR:		ESGUERRA, LAWRENZFACILITY TYPE:
300
ADDRESS:5533 ESQUIVEL AVETELEPHONE:
(310) 953-5072
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: CENSUS: DATE:
09/20/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:36 AM
MET WITH:Lawrence Esguerra - LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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Home Care Services Branch Enforcement Analysts (EA) Ryan Chan and Mila Quinto arrived at the business office of Amiable Homecare Incorporated on 9/20/24 for a post licensing inspection. Upon arrival, EAs identified themselves and was greeted by licensee Lawrence Esguerra. The proper posting of business hours and license was observed. The analysts were then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EAs discussed the findings of the inspection with the licensee. EAs informed the licensee of the deficiencies found and explained they would be noted on the 809D. Licensee was advised that home care aides (HCAs) without proof of negative tb test are not to be with clients.

EAs concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the licensee.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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 09/20/2024 10:52 AM - It Cannot Be Edited


Created By: Ryan Chan On 09/20/2024 at 10:37 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: AMIABLE HOMECARE INCORPORATED
FACILITY NUMBER: 194700867

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2024
Section Cited
1796.45(c)
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1796.45(c) After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection shall be required to undergo an examination at least once every two years....X-ray, the examination is no longer required.
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 (S2) completed tb test every 2 years 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: 09/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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