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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700048
Report Date: 11/19/2024
Date Signed: 11/19/2024 02:40:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/19/2024 02:40 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:SAN DIEGO HOMECAREFACILITY NUMBER:
374700048
ADMINISTRATOR/
DIRECTOR:		MAXINE E GARCIAFACILITY TYPE:
300
ADDRESS:1708 EOLUS AVETELEPHONE:
(858) 775-7761
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: CENSUS: DATE:
11/19/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Kevin Quinn TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On November 19, 2024, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of San Diego HomeCare. for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Licensee Kevin Quinn. Licensee Maxine Garcia arrived a short time later. 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 Quinn provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Six employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Licensee Kevin Quinn. 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: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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 3
Document Has Been Signed on 11/19/2024 02:40 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 11/19/2024 at 01:55 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: SAN DIEGO HOMECARE
FACILITY NUMBER: 374700048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2024
Section Cited
1796.43(a)
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Employees, Volunteers, and Affiliated Home Care Aide Requirements :(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:
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #1, #2 and #3 were not affiliated on the Home Care Registry, a finding which poses a potential health and safety risk to persons in care.
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Type B
12/16/2024
Section Cited
1796.44(c)
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Training requirements 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.
(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through an online training program.
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #1, #2, #3, #4, and #5 did not complete annual training for each year employed, 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: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/19/2024 02:40 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 11/19/2024 at 02:21 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: SAN DIEGO HOMECARE
FACILITY NUMBER: 374700048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2024
Section Cited
1796.44(a)(2)
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Training Requirements: A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section...(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:
During the review of files, it was observed that reference #1, #4, and #5 and #6 did not complete entry-level training as required, 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: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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