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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700121
Report Date: 04/11/2024
Date Signed: 04/11/2024 01:31:56 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/11/2024 01:31 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
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:HEALTHY AT HOME CAREGIVERSFACILITY NUMBER:
304700121
ADMINISTRATOR:CHIKUTURUDZI, PATRICIAFACILITY TYPE:
300
ADDRESS:24672 SAN JUAN AVE, SUITE 206TELEPHONE:
(949) 340-2617
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY: CENSUS: DATE:
04/11/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Patricia ChikuturudziTIME COMPLETED:
01:45 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analysts, Ramsey Chimienti and Mila Quinto, arrived at the business office of Healthy at Home Caregivers for a biennial inspection on 4/11/2024. Upon arrival, the HCSB analysts identified themselves and were greeted by Patricia Chikuturudzi. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Patricia. The analyst informed the Designee of the deficiencies found and explained they would be noted on the 809D.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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 04/11/2024 01:31 PM - It Cannot Be Edited


Created By: Ramsey Chimienti On 04/11/2024 at 12:45 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: HEALTHY AT HOME CAREGIVERS
FACILITY NUMBER: 304700121

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2024
Section Cited
1796.43 (a)
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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 INDICATE_NUMBER of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety 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: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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