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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700184
Report Date: 06/05/2024
Date Signed: 06/05/2024 02:24:15 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/05/2024 02:24 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:VISITING ANGELSFACILITY NUMBER:
374700184
ADMINISTRATOR/
DIRECTOR:		VAKILI, KEVINFACILITY TYPE:
300
ADDRESS:5500 GROSSMONT CENTER DR #201TELEPHONE:
(619) 303-6555
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: CENSUS: DATE:
06/05/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Alejandra RodriguezTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst Adrian Mangina arrived at the business office of Visiting Angels on 6/5/2024 for a Biennial inspection. Upon arrival, the HCSB analyst identified herself and was greeted by Designee Alejandra Rodriguez. Receptionist Christy Samson arrived a short time later. The proper posting of business hours and license were observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Analyst observed current insurance policies Upon completion of the file review the analyst discussed the findings of the inspection with Ms. Rodriguez and Ms Samson. The analyst informed the representatives 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: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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 06/05/2024 02:24 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 06/05/2024 at 02:04 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: VISITING ANGELS
FACILITY NUMBER: 374700184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
1796.44
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(a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
(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:
(1) Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control. (c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training.
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #2 and #5 did not have 5 hours required training 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: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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