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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700137
Report Date: 07/17/2024
Date Signed: 07/17/2024 03:49:25 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/17/2024 03:49 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:AKAHINA GROUP DBA AKAHINA HOME CAREFACILITY NUMBER:
334700137
ADMINISTRATOR/
DIRECTOR:		SANDRA ALVAREZFACILITY TYPE:
300
ADDRESS:42072 FIFTH ST STE 202CTELEPHONE:
(951) 434-7379
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: CENSUS: DATE:
07/17/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Katelyn ListerTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On July 17, 2024, 2024, Home Care Services Bureau (HCSB) Analyst Adrian Mangina arrived at the business office of Akahina Group DBA Akahina Home Care for a Biennial inspection. Upon arrival, the HCSB analyst identified herself and was greeted by Operations Manager Katelyn Lister. 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. Analyst observed current insurance policies and dishonesty bond. Upon completion of the file review the analyst discussed the findings of the inspection with the Designee Lister. 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: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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 07/17/2024 03:49 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 07/17/2024 at 02:53 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: AKAHINA GROUP DBA AKAHINA HOME CARE
FACILITY NUMBER: 334700137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2024
Section Cited
1796.45(c)
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1796.45(c): After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection shall be required to undergo an examination at least once every two years...
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #2, #4, #5, #6 and #9 did not have current negativeTB test a finding which poses an immediate health and safety risk to persons in care.
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Type A
07/18/2024
Section Cited
1796.43(a)
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1796.43(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...”
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #4 did not have active Home Care Aide registry listing (expired 3/10/24) a finding which poses an immediate health and safety risk to persons 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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/17/2024 03:49 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 07/17/2024 at 03:15 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: AKAHINA GROUP DBA AKAHINA HOME CARE
FACILITY NUMBER: 334700137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2024
Section Cited
1796.44(c)
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1796.44(c): (c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following ...
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #5 did not have completed current training records, a finding which poses a potential health and safety risk to persons 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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
LIC809 (FAS) - (06/04)
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