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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700070
Report Date: 05/25/2023
Date Signed: 06/02/2023 07:45:46 AM

Document Has Been Signed on 06/02/2023 07:45 AM - 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:JULIE'S IN HOME CAREFACILITY NUMBER:
334700070
ADMINISTRATOR:JULIE MARTINEZFACILITY TYPE:
300
ADDRESS:37957 GALLERY LANETELEPHONE:
(951) 544-0924
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY: CENSUS: DATE:
05/25/2023
Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julie MatinezTIME COMPLETED:
02:00 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst Ramsey Chimienti arrived at the business office of Julie's In Home Care for an initial inspection on 5/25/23. Upon arrival, the HCSB analyst identified himself and was greeted by Julie Martinez. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with the Ms. Martinez. The analyst informed the Licensee of the deficiencies found and explained they would be noted on the 809D
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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 06/02/2023 07:45 AM - It Cannot Be Edited


Created By: Ramsey Chimienti On 05/25/2023 at 12:56 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: JULIE'S IN HOME CARE
FACILITY NUMBER: 334700070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2023
Section Cited
1796.45 (a)
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1796.45
(a) Affiliated home care aides hired on or after January 1, 2016, 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.Staff #1 and #2 did not have a current TB clearance in their personnel folder at the time of the inspection. This poses an immediate health and safety risk to clients in care.
Type A
06/26/2023
Section Cited
1796.44
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1796.44
(a) 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.
Type A
06/26/2023
Section Cited
1796.23 (a)
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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 department, unless exempt under subdivision (d).
Registration status is not yet approved for Staff #1 and Staff #2. Registration for Staff #3 is in "Forfeited" status and must re-register before resuming care with clients.
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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: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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