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

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700339
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:56:09 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/29/2024 12:56 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:ABIDING HOME CARE, LLCFACILITY NUMBER:
304700339
ADMINISTRATOR/
DIRECTOR:		FELFELI, MINAFACILITY TYPE:
300
ADDRESS:23046 AVENIDA DELA CARLOTA 600TELEPHONE:
(949) 838-4620
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: CENSUS: DATE:
05/29/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Mitra FelfeliTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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 Bureau (HCSB) Analysts Adrian Mangina and Mila Quinto arrived at the business office of Abiding Home Care on 5/29/2024 for a Biennial inspection. Upon arrival, the HCSB analysts were informed that Licensee was not present at the shared office space. Analyst Mangina called Licensee, Mitra Felfeli, who agreed to come to the location with the administrative and staff files. Licensee arrived approximately 20 minutes later and was advised that staff files must be kept at the business address on file. Analysts Mangina and Quinto identified themselves and were shown to the office suite where the review of personnel and administrative files could be performed. Analysts observed the proper posting of business hours and license. Upon completion of the file review the analysts discussed the findings of the inspection with the Ms. Felfeli. The analyst informed the representative named above of the deficiencies found and explained they would be noted on the HCS809-D forms. In addition, the licensee was provided a copy of the HCS9058 Appeal Rights form.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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 3
Document Has Been Signed on 05/29/2024 12:56 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 05/29/2024 at 12:10 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: ABIDING HOME CARE, LLC
FACILITY NUMBER: 304700339

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2024
Section Cited
1796.43(a)
1
2
3
4
5
6
7
1796.43. (a) Home care organizations that employ affiliated home care aides shall …(1) Ensure any staff person, volunteer, or employee of a home care organization who has contact with clients, prospective clients, or confidential client information that may pose a risk to the clients’ health and safety has met the requirements of Sections 1796.23, 1796.24, 1796.25, 1796.26, and 1796.28 before there is contact with clients or prospective clients or access to confidential client information.
(2) Require home care aides to demonstrate that they are free of active tuberculosis disease, pursuant to Section 1796.45.
(3) Immediately notify the department when the home care organization no longer employs an individual as an affiliated home care aide.
(b) This section shall not prevent a licensee from requiring a criminal record clearance of any individual exempt from the requirements of this section, provided that the individual has client contact.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
During the review of files, it was observed that reference #2, #4, #6, #8 and #9 did not have TB test results, a finding which poses an immediate health and safety risks to persons 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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/29/2024 12:56 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 05/29/2024 at 12:22 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: ABIDING HOME CARE, LLC
FACILITY NUMBER: 304700339

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
1796.44
1
2
3
4
5
6
7
1796.44 A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section...a minimum of five hours of entry-level training prior to presence with a client, as follows: two hours of orientation training regarding his or her role as caregiver and…three hours of safety training, including basic safety precautions…a minimum of five hours of annual training.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
During the review of files, it was observed that Reference #3, #4, #8, and #10 did not have initial training records in file and #1, #7, and #9 staff did not have proper annual training hours, a finding which poses a potential health and safety risks to persons in care.
8
9
10
11
12
13
14
Type B
06/05/2024
Section Cited
1796.42(e)
1
2
3
4
5
6
7
1796.42(e) ...Report any suspected or known dependent adult or elder abuse as required by Section 15630... A copy of each suspected abuse report shall be maintained and available for review by the department during normal business hours.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
During the review of files, it was observed that staff, Reference #9, did not have a signed SOC341 on file, a finding which poses a potential health and safety risks to persons in care.
8
9
10
11
12
13
14
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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3