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

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700190
Report Date: 07/08/2025
Date Signed: 07/08/2025 03:14:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/08/2025 03:14 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:SENIOR HELPERS OF MENIFEE VALLEYFACILITY NUMBER:
334700190
ADMINISTRATOR/
DIRECTOR:		LAW, MUJAJI D.FACILITY TYPE:
300
ADDRESS:600 CENTRAL AVENUE, SUITE G2TELEPHONE:
(951) 674-3993
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: CENSUS: DATE:
07/08/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Mujaji Law, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:30 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
Enforcement Analyst (EA), Jane Cong-Huyen with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a 2 year required licensing visit. The EA met with licensee, Mujaji Law. The EA observed the posting of the license and operating business hours. Business operating hours are from 9:30am-5:30pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee and Home Care Aides including fingerprint status, registry status, Tuberculosis (TB), and required training(s). The HCO’s business records including document for insurance requirements were also reviewed during the visit.

Based on the file review, EA informed the licensee of the deficiency found and explained they would be noted on the 809D. An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) and appeal rights were provided to the licensee, Mujaji Law, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2025
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 07/08/2025 03:14 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 07/08/2025 at 02:48 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: SENIOR HELPERS OF MENIFEE VALLEY
FACILITY NUMBER: 334700190

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2025
Section Cited
1796.45(a)
1
2
3
4
5
6
7
1796.45(a) TB TESTING: 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. This requirement was not met as evidenced by: During the review of files on x/x/2025, Licensee could not provide proof of negative TB test/chest x-ray within 90 days of hire at time of inspection for staff #, # ;which poses an immediate health and safety risk to persons in care.
1
2
3
4
5
6
7
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: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2