<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700063
Report Date: 04/08/2025
Date Signed: 04/08/2025 01:34:57 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/08/2025 01:34 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:AVENUE MEDICAL EQUIPMENT, INCFACILITY NUMBER:
374700063
ADMINISTRATOR/
DIRECTOR:		MYO TUNFACILITY TYPE:
300
ADDRESS:2515 PIONEER AVE STE 3TELEPHONE:
(760) 978-6060
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: CENSUS: DATE:
04/08/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Kylin BrunikTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 8 2025, Home Care Services Bureau (HCSB) Enforcement Analyst (EA), Adrian Mangina arrived at the business office of Avenue Medical Equipment for a Biennial inspection. Upon arrival, the office was locked and closed. Enforcement Analyst called Designee Shelby Short, who stated she is on PTO, but that another Designee would arrive soon. Designee Kaylin Brunik arrived at approximately 10:40 AM and granted EA Mangina entry into the office suite. Analyst Mangina observed the proper posting of business hours. EA advised that the original License, not a copy should be posted in the premises. 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. Five employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Ms. Brunik. 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 Designee was provided a copy of the HCS9058 Appeal Rights form

NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025
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 4
Document Has Been Signed on 04/08/2025 01:34 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 04/08/2025 at 11:49 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: AVENUE MEDICAL EQUIPMENT, INC
FACILITY NUMBER: 374700063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2025
Section Cited
1796.44(c)
1
2
3
4
5
6
7
TRAINING REQUIREMENTS: In addition to the requirements in subdivision (b), 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: Clients’ rights and safety, How to provide for, and respond to, a client’s daily living needs, How to report, prevent, and detect abuse and neglect., How to assist a client with personal hygiene and other home care services, If transportation services are provided, how to safely transport a client.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: During the review of files on 4/8/25 Licensee was not able to provide proof that Reference #2 and #5 have completed 5 of 5 hours of required hours annual training at time of inspection including: Clients’ rights and safety, How to provide for, and respond to, a client’s daily living needs, How to report, prevent, and detect abuse and neglect, How to assist a client with personal hygiene and other home care service, If transportation services are provided, how to safely transport a client, and Reference #1, #3, and #4 have completed 4 of 5 hours of required hours annual training at time of inspection including: clients rights and safety, How to provide for, and respond to, a client’s daily living needs, How to assist a client with personal hygiene and other home care services, If transportation services are provided, how to safely transport a client at time of inspection, a finding which poses a potential health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 04/08/2025 01:34 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 04/08/2025 at 12:10 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: AVENUE MEDICAL EQUIPMENT, INC
FACILITY NUMBER: 374700063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2025
Section Cited
1796.44(b)(1)
1
2
3
4
5
6
7
TRAINING REQUIRMENTS: An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows: Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: During the review of files on 4/8/25 Licensee was not able to provide proof at time of inspection that Reference #1, #2, #3, #4, aand #5 completed entry-level 2-hour entry-level orientation training, a finding which poses an immediate health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
8
9
10
11
12
13
14
8
9
10
11
12
13
14
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: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 04/08/2025 01:34 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 04/08/2025 at 12:44 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: AVENUE MEDICAL EQUIPMENT, INC
FACILITY NUMBER: 374700063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2025
Section Cited
1796.44(b)(2)
1
2
3
4
5
6
7
TRAINING REQUIREMENTS:(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:... three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: During the review of files on 4/8/25 Licensee was not able to provide at time of inspection proof that Reference #1 and #5, completed 3 of 3 hours entry-level training including basic safety precautions, emergency procedures, and infection control and Reference #2, #3, and #4 completed 2 of 3 hours entry-level training including basic safety precautions and emergency procedures, a finding which poses an immediate health and safety risk to persons in care.
8
9
10
11
12
13
14
Type A
04/09/2025
Section Cited
1796.45(a)
1
2
3
4
5
6
7
TB TESTING: 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
8
9
10
11
12
13
14
This requirement was not met as evidenced by: During the review of files on 4/23/25 Licensee could not provide proof of negative TB test within 90 days of hire at time of inspection for reference #3 as hire date was 9/25/2019 and TB chest xray was dated 11/12/2012, a finding which poses an immediate health and safety risk to persons in care,
8
9
10
11
12
13
14
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: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4