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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700067
Report Date: 09/16/2024
Date Signed: 09/16/2024 01:30:57 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/16/2024 01:30 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:SENIORS WHO HELP SENIORS INC.FACILITY NUMBER:
374700067
ADMINISTRATOR/
DIRECTOR:		MATTHEW WALTER OBERMUELLERFACILITY TYPE:
300
ADDRESS:577 E ELDER ST STE UTELEPHONE:
(760) 884-4111
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: CENSUS: DATE:
09/16/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Matthew Walter ObermuellerTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Seniors Who Help Seniors Inc. on September 16, 2024 for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Licensee Matthew Walter Obermueller. 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 provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with the Licensee Obermueller. 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: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
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 09/16/2024 01:30 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 09/16/2024 at 12:38 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: SENIORS WHO HELP SENIORS INC.
FACILITY NUMBER: 374700067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2024
Section Cited
1796.44(c)
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Training:.. affiliated home care aide shall complete a minimum of five hours of annual training... shall relate to core competencies... which shall include, but not be limited to, the following areas: Clients’ rights and safety....client’s daily living needs...How to report, prevent, and detect abuse and neglect...
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This requirement was not met as evidence by:
This requirement was not met as evidenced by:Based on record review, it was observed that four of six staff (#2, #3, #4, #5) did not have current annual training records or historical training records, a finding which poses a potential health and safety risk to persons in care.
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09/16/2024
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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: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/16/2024 01:30 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 09/16/2024 at 12:42 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: SENIORS WHO HELP SENIORS INC.
FACILITY NUMBER: 374700067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/23/2024
Section Cited
1796.45(c)
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TB:(c) After submitting to an examination, an. affiliated home care aide whose test for tuberculosis infection shall be required to undergo an examination at least once every two years...Affiliated home care aides... shall submit to an examination 90 days prior to employment, or within seven days after...
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Based on record review, it was observed that Staff#5 had a TB test that expired 9/9/24, also Staff #5 and staff #6 had TB tests that were more than 90 days old, a finding which poses a 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: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
LIC809 (FAS) - (06/04)
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