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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700145
Report Date: 01/17/2025
Date Signed: 01/17/2025 11:20:42 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/17/2025 11:20 AM - 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:NIGHTINGALE SENIOR CAREFACILITY NUMBER:
304700145
ADMINISTRATOR/
DIRECTOR:		SONIA CHHABRAFACILITY TYPE:
300
ADDRESS:550 E. LAMBERT RD.TELEPHONE:
(657) 217-2273
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: CENSUS: DATE:
01/17/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kathy Johnson - Office ManagerTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan and Jane Cong-Huyen arrived at the business office of Nightingale Senior Care on 1/17/25 for a biennial inspection. Upon arrival, EAs were greeted by Kathy Johnson, Office Manager. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. EAs were then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EAs discussed the findings of the inspection with Kathy Johnson, Office Manager. EAs informed her of the deficiencies found and explained they would be noted on the 809D.

EAs concluded the visit with an exit interview and provided a copy of this report along with appeal rights to Kathy Johnson.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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 01/17/2025 11:20 AM - It Cannot Be Edited


Created By: Ryan Chan On 01/17/2025 at 10:21 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: NIGHTINGALE SENIOR CARE
FACILITY NUMBER: 304700145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2025
Section Cited
1796.44 (b)(2)
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1796.44 (b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows:...(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 aides (HCA) (S1, S3, S4, S5, S6, S7, S8, S9, S10) completed all 3 hours of safety training required which poses a potential risk to the health and safety of clients in care.
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Type B

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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: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/17/2025 11:20 AM - It Cannot Be Edited


Created By: Ryan Chan On 01/17/2025 at 10:53 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: NIGHTINGALE SENIOR CARE
FACILITY NUMBER: 304700145

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2025
Section Cited
1796.44(c)
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1796.44(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
(1) Clients’ rights and safety.
(2) How to provide for and respond to a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client.
(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through an online training program.
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Based on records reviewed licensee did not ensure home care aides (HCA) (S2, S3, S4, S5, S6, S7, S8, S9) completed all 5 hours of annual training required 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: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
LIC809 (FAS) - (06/04)
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