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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700206
Report Date: 02/06/2025
Date Signed: 02/06/2025 04:24:16 PM

Document Has Been Signed on 02/06/2025 04:24 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:ELDER LOVE USA, INCFACILITY NUMBER:
334700206
ADMINISTRATOR/
DIRECTOR:		SHEA, SHANNONFACILITY TYPE:
300
ADDRESS:41550 ECLECTIC STREETTELEPHONE:
(888) 336-8322
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: CENSUS: DATE:
02/06/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Shannon SheaTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Enforcement Analysts, Jane Cong-Huyen and Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a Post Licensing visit. The EAs met with licensee, Shannon Shea. The EAs observed the posting of the license and operating business hours. Business operating hours are from 8am-5pm, Monday thru Friday.

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

Based on the file review, EAs informed the licensee of the deficiency found and explained they would be noted on the 809D.

EAs provided a copy of the report, Review of Staff Records form, and appeal rights to the licensee, Shannon Shea, via email.

LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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 3
Document Has Been Signed on 02/06/2025 04:24 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 02/06/2025 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: ELDER LOVE USA, INC
FACILITY NUMBER: 334700206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2025
Section Cited
1796.14 (b)
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1796.14(b) - (b) An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client.
This requirement is not met as evidence by: based on file review. HCA #4 & #8 did not a valid home care registry. This poses an immedicate health & safety code to clients in care.
Type A
02/07/2025
Section Cited
1796.45 (a)
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1796.45 (a) - (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. This requirement is not et as evidence by: based on file review. HCA #1, #4, #5 did not have proof of TB clearance on file. This poses an immediate health & safety risk to clients 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: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/06/2025 04:24 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 02/06/2025 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: ELDER LOVE USA, INC
FACILITY NUMBER: 334700206

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2025
Section Cited
1796.44 (b)
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1796.44 (b) Training Requirement: (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. This requirement is not met as evidence by: based on file review. HCA #1, 3,5,6,7,8 does not have required training. This poses a potential risk to the health & safety of 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: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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