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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700284
Report Date: 09/12/2024
Date Signed: 09/12/2024 03:01:13 PM

Document Has Been Signed on 09/12/2024 03:01 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:HEARTS IN HOME SENIOR CARE PROVIDERFACILITY NUMBER:
304700284
ADMINISTRATOR/
DIRECTOR:		JENNY CASTELLANOSFACILITY TYPE:
300
ADDRESS:135 S STATE COLLEGE BLVD #200TELEPHONE:
(951) 216-8130
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: CENSUS: DATE:
09/12/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Jenny Castellanos, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Enforcement Analysts (EAs), Mila Quinto and Ryan Chan arrived at the business office of Hearts in Home Senior Care Provider for a post licensing inspection. Upon arrival, EAs were greeted by a staff member, Marie Butler. At 1:30pm, licensee, Jenny Castellanos arrived. The proper posting of business hours and license was observed. The proof of insurance's record ss reviewed. EAs reviewed the personnel and administrative files. Based on the file review, EAs informed the licensee of the deficiency found and explained they would be noted on the 809D.

The analyst provided a copy of the report to the designee via email.

LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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 09/12/2024 03:01 PM - It Cannot Be Edited


Created By: Mila Quinto On 09/12/2024 at 02:28 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: HEARTS IN HOME SENIOR CARE PROVIDER
FACILITY NUMBER: 304700284

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
1796.45(a)
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1796.45 TB Testing (a) Affiliated home care aides hired...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 file review of 10 random HCA files, 4 of 10 files review did not have a current tb clearance.
This poses a potential health and safety risk to the clients in care.
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Type B
09/18/2024
Section Cited
1796.44(a)
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1796.44 Training Requirements (a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
This requirement is not met as evidenced by:
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Based on file review, 9 of 10 of the HCA files did not have the training records for review. This poses a potential health and safety risk to the 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
LIC809 (FAS) - (06/04)
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