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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700057
Report Date: 02/03/2025
Date Signed: 02/03/2025 11:42:51 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/03/2025 11:42 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:A CARING HEART SENIOR CARE INCFACILITY NUMBER:
374700057
ADMINISTRATOR/
DIRECTOR:		MONICA ALLANFACILITY TYPE:
300
ADDRESS:371 E. MILLAN ST, #5TELEPHONE:
(619) 585-1877
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: CENSUS: DATE:
02/03/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Marti KingTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On February 3, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst (EA) Adrian Mangina arrived at the business office of A Caring Heart Senior Care Inc. for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Marti King. 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. Designee provided Analyst with proof of current professional liability policy, worker's compensation, and dishonesty bond. Ten employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Designee King. The Analyst informed the representative named above of the deficiencies found and explained they would be noted on the HCS809-D form. In addition, the Designee was provided a copy of the HCS9058 Appeal Rights form.

LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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 02/03/2025 11:42 AM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/03/2025 at 11:01 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: A CARING HEART SENIOR CARE INC
FACILITY NUMBER: 374700057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2025
Section Cited
1796.45(a)
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TB TESTING : (a) 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: during the review of files it was observed that Licensee could not provide proof of current TB test for reference #2, #6, and #8, and Analyst could not determine date of TB test for reference #3 as copy was illegible, 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: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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