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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 344700044
Report Date: 03/26/2024
Date Signed: 03/26/2024 09:47:20 AM

Document Has Been Signed on 03/26/2024 09:47 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:LOVING COMPANIONSFACILITY NUMBER:
344700044
ADMINISTRATOR:JEFFREY BONDFACILITY TYPE:
300
ADDRESS:6846 BOA NOVA DRTELEPHONE:
(916) 235-3304
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: CENSUS: DATE:
03/26/2024
Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jeffery BondTIME COMPLETED:
10:00 AM
NARRATIVE
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Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office of Loving Companions for a Biennial Inspection at approximately 8:30am.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Jeffery Bond. 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, AGPA Vigil discussed the findings of the inspection with the Licensee. Deficiencies were found and are noted on the 809D with a plan of corrections.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 03/26/2024 09:47 AM - It Cannot Be Edited


Created By: Megan Vigil On 03/26/2024 at 09:32 AM
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: LOVING COMPANIONS
FACILITY NUMBER: 344700044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/02/2024
Section Cited
1796.43 (a)
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...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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Proof of clearance on the Licensee Registry was not documented in personnel records that were reviewed by HCSB analyst. This poses an immediate health and 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: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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