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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701058
Report Date: 10/10/2025
Date Signed: 10/10/2025 05:27:58 PM

Document Has Been Signed on 10/10/2025 05:27 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:SYNERGY HOMECARE DUARTEFACILITY NUMBER:
194701058
ADMINISTRATOR/
DIRECTOR:		CAROLINE OGUNJIFACILITY TYPE:
300
ADDRESS:1851 HUNTINGTON DRIVE SUITE 89TELEPHONE:
(909) 317-7087
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY: CENSUS: DATE:
10/10/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Emmanuel Ogunji - LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Synergy Homecare Duarte on 10/10/25 for a post licensing inspection. EA met with licensee Emmanuel Ogunji. 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 licensee and informed him of the deficiencies found and explained they would be noted on the 809D. EA advised that home care aides without proof of negative tb test within 2 years should not be placed with clients.

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

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
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 10/10/2025 05:27 PM - It Cannot Be Edited


Created By: Ryan Chan On 10/10/2025 at 03:27 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
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: SYNERGY HOMECARE DUARTE
FACILITY NUMBER: 194701058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2025
Section Cited
1796.45(a)
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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.
This requirement was not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aides (HCA) S1, S2, S3, and S4 had proof of negative tb within 90 days prior to employment or within 7 days after employment prior to placing HCAs with clients 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: 10/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/10/2025 05:27 PM - It Cannot Be Edited


Created By: Ryan Chan On 10/10/2025 at 03:33 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
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: SYNERGY HOMECARE DUARTE
FACILITY NUMBER: 194701058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2025
Section Cited
1796.44 (b)(2)
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1796.44 (b)(2).......(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
This requirement is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aide (HCA) S3 sompleted 3 hours of safety training which poses a potential 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: 10/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
LIC809 (FAS) - (06/04)
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