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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700200
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:25:48 PM

Document Has Been Signed on 10/30/2024 04:25 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:EVER READY HOME CARE SERVICE LLCFACILITY NUMBER:
334700200
ADMINISTRATOR/
DIRECTOR:		ANDREA NUNEZFACILITY TYPE:
300
ADDRESS:24135 HIBISCUS LN.TELEPHONE:
(951) 200-4134
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY: CENSUS: DATE:
10/30/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Arveal HawkinsTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On October 30, 2024, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Ever Ready Home Care Service LLC for a Post Licensing inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Licensee Arveal Hawkins. Analyst Mangina observed the proper posting of business hours and license. The analyst was provided an area in which the review of personnel and administrative files could be performed. Licensee provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Three employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with the Licensee Hawkins. 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: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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 4
Document Has Been Signed on 10/30/2024 04:25 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/30/2024 at 02:33 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: EVER READY HOME CARE SERVICE LLC
FACILITY NUMBER: 334700200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/30/2024
Section Cited
1796.43(a)
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Employees, Volunteers, and Affiliated Home Care Aide Requirements: 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:
Based on file review, it was observed that reference #3 was not affiliated on the home Care registry, a finding which poses an immediate health and safety risk to persons in care.
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Type A

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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: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/30/2024 04:25 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/30/2024 at 03:00 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: EVER READY HOME CARE SERVICE LLC
FACILITY NUMBER: 334700200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2024
Section Cited
1796.45(a)
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TB Testing: Affiliated home care aides...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.
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This requirement was not met as evidenced by:
Based on file review, it was observed that reference #1 and #2 did not have negative TB tests, a finding which poses an immediate health and safety risk to persons in care.
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Type A
10/31/2024
Section Cited
1796.44(b)
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Training Requirements:(b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows:(1) Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
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This requirement was not met as evidenced by:
Based on file review, it was observed that reference #1, #2 and #3 did not have completed entry=level training 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: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/30/2024 04:25 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/30/2024 at 03:08 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: EVER READY HOME CARE SERVICE LLC
FACILITY NUMBER: 334700200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2024
Section Cited
1796.44 (c)
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Training Requirements: (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 areas:
(1) Clients’ rights and safety, (2) How to provide for, and respond to, a client’s daily living needs, (3) How to report, prevent, and detect abuse and neglect,(4) How to assist a client with personal hygiene and other home care services,(5) If transportation services are provided, how to safely transport a client.
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This requirement was not met as evidenced by:
Based on file review, it was observed that reference #3 did not have proof of annual training in file, 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: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
LIC809 (FAS) - (06/04)
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