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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700902
Report Date: 10/06/2025
Date Signed: 10/06/2025 12:19:00 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/06/2025 12:19 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:1 BELOVED CARE AGENCYFACILITY NUMBER:
194700902
ADMINISTRATOR/
DIRECTOR:		CHERUTO, ELIZABETHFACILITY TYPE:
300
ADDRESS:4540 N LARK ELLEN AVE #30TELEPHONE:
(562) 349-2814
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: CENSUS: DATE:
10/06/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Clement Muinde and Elizabeth Cheruto - LIcenseesTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of 1 Beloved Care Agency on 10/6/25 for a biennial inspection. EA met with licensees Clement Muinde and Elizabeth Cheruto. The proper posting of business hours and license was observed. The proof of insurance records were reviewed. 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 licensees. EA informed them of the deficiencies found and explained they would be noted on the 809D. EA advised licensees that home care aides without proof of negative tb and active home care aide registry are not to be with clients.

EA Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the licensees.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
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 10/06/2025 12:19 PM - It Cannot Be Edited


Created By: Ryan Chan On 10/06/2025 at 11:35 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: 1 BELOVED CARE AGENCY
FACILITY NUMBER: 194700902

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2025
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 is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aide (S1) was cleared on the home care aide (HCA) registry, the registry for S1 expired on 2/9/25. This poses an immediate risk to the health and safety of clients in care.
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Type A
10/13/2025
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 is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aide (S1) had proof of negative tuberculosis on file 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: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
LIC809 (FAS) - (06/04)
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