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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 344700087
Report Date: 12/06/2021
Date Signed: 12/06/2021 03:38:31 PM

Document Has Been Signed on 12/06/2021 03:38 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:GW PINEAPPLE CO DBA BRIGHTSTAR CARE FOLSOM/EDHFACILITY NUMBER:
344700087
ADMINISTRATOR:GIANNELLI, DAVIDFACILITY TYPE:
300
ADDRESS:1831 IRON POINT RD STE120TELEPHONE:
(916) 833-3500
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 0CENSUS: DATE:
12/06/2021
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:David Giannelli and Lori WinsorTIME COMPLETED:
04:00 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Ramsey Chimienti arrived at the business office of BRIGHTSTAR CARE OF FOLSOM/EDH on 12/6/2021. Upon arrival, the HCSB analyst identified himself and was greeted by Licensee David Giannelli and Designee Lori Winsor. 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 the analyst discussed the findings of the inspection with the David and Lori. The analyst informed them of the deficiencies found and explained they would be noted on the HCS 809D.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2021
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 05/13/2022 12:41 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/16/2021 11:02 AM


Created By: Ramsey Chimienti On 12/06/2021 at 03:29 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: GW PINEAPPLE CO DBA BRIGHTSTAR CARE FOLSOM/EDH
FACILITY NUMBER: 344700087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2022
Section Cited
1796.42(e)
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1796.42(e)
(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. In addition, the home care organization shall do all of the following:
(1) Ensure any staff person, volunteer, or employee of a home care organization who has contact with clients, prospective clients, or confidential client information that may pose a risk to the clients’ health and safety has met the requirements of Section 1796.23 before being hired.
1796.23
(a) Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the State Department of Social Services, unless exempt under subdivision (d). Each person initiating a background examination to be a registered home care aide shall also submit to the State Department of Social Services a signed declaration under penalty of perjury regarding any prior criminal convictions pursuant to Section 1522 and a completed home care aide application.
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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: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2021
LIC809 (FAS) - (06/04)
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