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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700995
Report Date: 08/20/2024
Date Signed: 08/20/2024 02:35:43 PM

Document Has Been Signed on 08/20/2024 02:35 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:HEALING HANDS HOME CARE LLCFACILITY NUMBER:
194700995
ADMINISTRATOR/
DIRECTOR:		ESCUADRO, CLARIFELLE DIANEFACILITY TYPE:
300
ADDRESS:11836 DOTY AVE.TELEPHONE:
(310) 491-6715
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: CENSUS: DATE:
08/20/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Clarissa EscuadroTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analysts (EA) Ryan Chan and Mila Quinto arrived at the business office of Healing Hands Home Care LLC on 8/20/24 for a post licensing inspection. Upon arrival, the analysts identified themselves and were greeted by licensee Clarissa Escuadro. 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 the analysts discussed the findings of the inspection with the licensee. The analysts informed the licensee of the deficiencies found and explained they would be noted on the 809D. Analysts advised licensee that home care aides that did not have proof of registry and TB test were not to be with clients.

Analysts 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: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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 3
Document Has Been Signed on 08/20/2024 02:35 PM - It Cannot Be Edited


Created By: Ryan Chan On 08/20/2024 at 02:04 PM
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: HEALING HANDS HOME CARE LLC
FACILITY NUMBER: 194700995

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/20/2024
Section Cited
1796.45(b)
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1796.45(b) For purposes of this section, “examination” means a test for tuberculosis...The aide shall not work as an affiliated home care aide unless the licensee obtains documentation from a licensed medical professional that there is no risk of spreading the disease.
This requirement was not met as evidenced by:
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Based on records reviewed licensee failed to obtain TB test result documentation from home care aide staff (S1, S3) which poses an immediate risk to clients in care.
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Type A
08/20/2024
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 evidenced by:
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Based on records reviewed licensee failed to ensure home care aide staff (S1) is cleared on the home care aide registry 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: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/20/2024 02:35 PM - It Cannot Be Edited


Created By: Ryan Chan On 08/20/2024 at 02:18 PM
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: HEALING HANDS HOME CARE LLC
FACILITY NUMBER: 194700995

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2024
Section Cited
1796.44(a)
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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.
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Based on records reviewed licensee did not provide training to home care aide staff (S3) which poses a potential 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: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3