Community Care Licensing

Document Has Been Signed on 12/21/2021 03:56 PM - It Cannot Be Edited

FACILITY NAME:	HOMEWELL CARE SERVICES		FACILITY NUMBER:	314700022
ADMINISTRATOR:	SAMANTHA MCCOY		FACILITY TYPE:	300
ADDRESS:	300 HARDING BLVD, STE 214		TELEPHONE:	(916) 751-5000
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY: 0		CENSUS:	DATE:	12/21/2021
	Case Management - Biennial Required Continuation	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Samantha McCoy		TIME COMPLETED:	04:00 PM

LICENSING EVALUATOR NAME: Ramsey Chimienti LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021

Link to Parent Document Below:

FACILITY NAME: HOMEWELL CARE SERVICES	FACILITY NUMBER: 314700022
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/21/2022 Section Cited 1796.37 (a)	1 2 3 4 5 6 7	1796.37 (a)(2)(12) (a) A home care organization that has its principal place of business in another state, in addition to the other requirements of this chapter, before arranging for home care services provided by an affiliated home care aide to a client in the state, shall comply with all of the following: (2) Maintain all pertinent records of the operation in California at the California office. All records shall be available to review, copy, audit, and inspect by the licensing agency. (12) Provides any other information as may be required by the department for the proper administration and enforcement of this chapter.
Type B 01/21/2022 Section Cited 1796.23 (a)	1 2 3 4 5 6 7	1796.23 (a) (a) Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the State Department of Social Services, unless exempt under subdivision (d). Each person initiating a background examination to be a registered home care aide shall also submit to the State Department of Social Services a signed declaration under penalty of perjury regarding any prior criminal convictions pursuant to Section 1522 and a completed home care aide application.
Type B 01/21/2022 Section Cited 1796.42(a)	1 2 3 4 5 6 7	1796.42(a)(1), 1796.23 (a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients. In addition, the home care organization shall do all of the following: (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 Section 1796.23 before being hired. 1796.23 (a) Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the State Department of Social Services, unless exempt under subdivision (d). Each person initiating a background examination to be a registered home care aide shall also submit to the State Department of Social Services a signed declaration under penalty of perjury regarding any prior criminal convictions pursuant to Section 1522 and a completed home care aide application.
Type B 01/21/2022 Section Cited 1796.45	1 2 3 4 5 6 7	1796.45 (a) An individual hired to be an affiliated home care aide on or after January 1, 2015, shall be submitted 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. (b) For purposes of this section, “examination” means a test for tuberculosis infection that is recommended by the federal Centers for Disease Control and Prevention (CDC) and that is licensed by the federal Food and Drug Administration (FDA) and, if that test is positive, an X-ray of the lungs. The aide shall not work as an affiliated home care aide unless he or she obtains documentation from a licensed medical professional that there is no risk of spreading the disease. (c) An affiliated home care aide whose employment with a home care organization began before January 1, 2015, shall submit to the examination described in subdivision (a) before July 1, 2015. (d) After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection is negative shall be required to undergo an examination at least once every two years. Once an affiliated home care aide has a documented positive test for tuberculosis infection that has been followed by an X-ray, the examination is no longer required. (e) After the examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease. (f) The examination is a condition of initial and continuing employment with the home care organization. The affiliated home care aide shall pay the cost of the examination. (g) An affiliated home care aide who transfers employment from one home care organization to another shall be deemed to meet the requirements of subdivision (a) or (c) if the affiliated home care aide can produce a certificate showing that he or she submitted to the examination within the past two years and was found to be free of active tuberculosis disease, or if it is verified by the home care organization previously employing him or her that it has a certificate on file that contains that showing.

LICENSING EVALUATOR NAME: Ramsey Chimienti LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021