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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701125
Report Date: 02/26/2025
Date Signed: 02/26/2025 03:03:47 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/26/2025 03:03 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:1HEART CAREGIVER SERVICESFACILITY NUMBER:
194701125
ADMINISTRATOR/
DIRECTOR:		TAGARAO, KEVINFACILITY TYPE:
300
ADDRESS:1050 LAKES DRIVE STE 225TELEPHONE:
(818) 906-4441
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY: CENSUS: DATE:
02/26/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Erika Arizmendi - Recruitment SpecialistTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of 1Heart Caregivers Services on 2/26/25 for a biennial inspection. Upon arrival, EA was greeted by Recruitment Specialist Erika Arizmendi. The proof of insurance's record was 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 Ms. Arizmendi and Chief Operating Officer Kevin Tagarao who was on the phone. EA advised that home care aides are not allowed to be with clients until proof of negative tb has been received and verified by the licensee. EA informed them of the deficiencies found and explained they would be noted on the 809D.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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 02/26/2025 03:03 PM - It Cannot Be Edited


Created By: Ryan Chan On 02/26/2025 at 11:55 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: 1HEART CAREGIVER SERVICES
FACILITY NUMBER: 194701125

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2025
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 is not met as evidenced by:
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Based on records reviewed licensee diid not ensure home care aide (S7) had proof of negative tuberculosis test on file which poses an immedicate 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: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
LIC809 (FAS) - (06/04)
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