Community Care Licensing

Document Has Been Signed on 08/28/2023 03:31 PM - It Cannot Be Edited

FACILITY NAME:	CARE SPECIALIST HCS INC DBA PREMIER HOME CARE		FACILITY NUMBER:	194700937
ADMINISTRATOR:	OMBRA, EDRIS		FACILITY TYPE:	300
ADDRESS:	17050 CHATSWORTH ST #208		TELEPHONE:	(818) 849-6415
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:		CENSUS:	DATE:	08/28/2023
	Post Licensing	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Omar Ombra		TIME COMPLETED:	03:00 PM

LICENSING EVALUATOR NAME: Ramsey Chimienti LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023

Document is an Amendment of Original Document on 09/25/2023 09:20 AM

Link to Parent Document Below:

FACILITY NAME: CARE SPECIALIST HCS INC DBA PREMIER HOME CARE	FACILITY NUMBER: 194700937
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/11/2023 Section Cited 1796.43 (a)	1 2 3 4 5 6 7	Health and Safety Code § 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. Proof of clearance on the Home Care Aide Registry was not documented in any of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.
Type A 09/11/2023 Section Cited 1796.23 (a)	1 2 3 4 5 6 7	Health and Safety Code § 1796.23 (a) Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d). Criminal Background Clearance and/or Exemption approval was not obtained for any of the caregivers on staff. This poses an immediate health and safety risk to clients in care.
Type A 09/04/2023 Section Cited 1796.45 (a)	1 2 3 4 5 6 7	Health and Safety Code § 1796.45 (a) Affiliated home care aides hired on or after January 1, 2016, 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. TB clearance was not documented in any of the caregiver’s personnel records that were reviewed by HCSB analyst except for one individual. This poses an immediate health and safety risk to clients in care.
Type B 09/28/2023 Section Cited 1796.42 (e)	1 2 3 4 5 6 7	Health and Safety Code § 1796.42 (e) A home care organization licensee shall do all of the following: Report any suspected or known dependent adult or elder abuse as required by Section 15630 of the Welfare and Institutions Code and suspected or known child abuse as required by Sections 11164 to 11174.3, inclusive, of the Penal Code. A copy of each suspected abuse report shall be maintained and available for review by the department during normal business hours. Signed acknowledgement to report suspected elder abuse was not documented in any of the caregiver’s personnel records that were reviewed by HCSB analyst.

LICENSING EVALUATOR NAME: Ramsey Chimienti LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023

Document is an Amendment of Original Document on 09/25/2023 09:26 AM

Link to Parent Document Below:

FACILITY NAME: CARE SPECIALIST HCS INC DBA PREMIER HOME CARE	FACILITY NUMBER: 194700937
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/28/2023 Section Cited 1796.44	1 2 3 4 5 6 7	Health and Safety Code § 1796.44(a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section. A record of completion of the required training hours and topics was not documented in any of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses a potential health and safety risk to clients in care.
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LICENSING EVALUATOR NAME: Ramsey Chimienti LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023