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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700886
Report Date: 05/09/2024
Date Signed: 05/10/2024 08:07:46 AM

Document Has Been Signed on 05/10/2024 08:07 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:RELIABLE HOME CARE, INC.FACILITY NUMBER:
194700886
ADMINISTRATOR/
DIRECTOR:		PASCUAL, JENNIFERFACILITY TYPE:
300
ADDRESS:16900 S LAKEWOOD BLVD STE 207TELEPHONE:
(562) 481-9843
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: CENSUS: DATE:
05/09/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Jennifer Pascual, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On May 9, 2024, Home Care Services Bureau Associate Governmental Program Analyst (AGPA) Joshua Rarela arrived at the Home Care Organization (HCO) listed above. Upon arrival, the AGPA identified himself and was greeted by the HCO administrator.

The proper posting of business hours and license were observed. The AGPA was shown to an area
where the review of personnel and administrative files could be performed. Upon completion of the file review,
the AGPA discussed the findings of the inspection with the administrator. The AGPA informed the administrator of the deficiencies found and explained they would be noted on the HCS809-D. In addition, the licensee was provided a copy of the LIC 9058 (Applicant/Licensee Rights) form.
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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 05/10/2024 08:07 AM - It Cannot Be Edited


Created By: Joshua Rarela On 05/09/2024 at 11:26 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: RELIABLE HOME CARE, INC.
FACILITY NUMBER: 194700886

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2024
Section Cited
1796.44
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(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section ... affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client ... and home care aide shall complete a minimum of five hours of annual training.
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This requirement is not met as evidenced by:

During the review of files, it was observed that staff did not have proper initial and annual training hours, a finding which poses a potential health and safety risks 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: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
LIC809 (FAS) - (06/04)
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