<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700201
Report Date: 08/15/2024
Date Signed: 08/15/2024 01:51:30 PM

Document Has Been Signed on 08/15/2024 01:51 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:CREATIVE HOME CAREFACILITY NUMBER:
304700201
ADMINISTRATOR/
DIRECTOR:		APRIL GEMORAFACILITY TYPE:
300
ADDRESS:32 PASEO BREZOTELEPHONE:
(949) 702-0008
CITY:RCHO STA MARGSTATE: CAZIP CODE:
92688
CAPACITY: CENSUS: DATE:
08/15/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:April Gemora, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Home Care Services Branch (HCSB) Analyst, Mila Quinto arrived at the business office of Creative Home Care for an initial biennial inspection visit. Upon arrival, Analyst Quinto was greeted by designee, April Gemora. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. The Analyst reviewed the personnel and administrative files. Upon completion of the file review the analyst discussed the findings of the inspection with the Licensee. The analyst informed the Licensee of the deficiency found and explained they would be noted on the 809D.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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 2
Document Has Been Signed on 08/15/2024 01:51 PM - It Cannot Be Edited


Created By: Mila Quinto On 08/15/2024 at 10:48 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: CREATIVE HOME CARE
FACILITY NUMBER: 304700201

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2024
Section Cited
1796.14(b)
1
2
3
4
5
6
7
1796.14 Scope of Requirements for HCAs(b) An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client.
This requirement is not met as evidenced by:
8
9
10
11
12
13
14
Based on interview with licensee states she care for clients. However per home care registry, it is not valid.
This poses a potential health and safety risk to the clients in care
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2