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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700357
Report Date: 09/12/2024
Date Signed: 09/12/2024 01:10:46 PM

Document Has Been Signed on 09/12/2024 01:10 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:INFINITY AND BEYOND HOMECARE INCFACILITY NUMBER:
304700357
ADMINISTRATOR/
DIRECTOR:		SAN DIEGO, CHRISTINAFACILITY TYPE:
300
ADDRESS:135 S STATE COLLEGE BLVD. #200TELEPHONE:
(714) 576-7230
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: CENSUS: DATE:
09/12/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Christina San Diego, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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Enforcement Analysts (EAs), Mila Quinto and Ryan Chan arrived at the business office of Infinity and Beyond Homecare Inc. for a post licensing inspection. Upon arrival, EAs were greeted by the Licensee, Christina San Diego. The proper posting of business hours and license was observed. The proof of insurance's record was 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)
Page: 1 of 2
Document Has Been Signed on 09/12/2024 01:10 PM - It Cannot Be Edited


Created By: Mila Quinto On 09/12/2024 at 12:50 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: INFINITY AND BEYOND HOMECARE INC
FACILITY NUMBER: 304700357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2024
Section Cited
1976.44(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...This requirement is not met as evidenced by:
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Based on file review, licensee stated they only have 7 active HCA. Per file review, the training file were not available for review as all training are kept electronically. Due to the location of the office, the internet access were not available.
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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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