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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700211
Report Date: 02/21/2025
Date Signed: 02/26/2025 07:21:57 AM

Document Has Been Signed on 02/26/2025 07:21 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:VISITING ANGELSFACILITY NUMBER:
374700211
ADMINISTRATOR/
DIRECTOR:		ADRIAN J PETERSFACILITY TYPE:
300
ADDRESS:1231 THIRD AVE STE ETELEPHONE:
(619) 882-5223
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: CENSUS: DATE:
02/21/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Jocelyn ValadezTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On February 21, 2025 Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Visiting Angels for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Care Manager Jocelyn Valadez Owner Adrian Peters was unavailable to attend this inspection. Analyst Mangina observed the proper posting of business hours and license. Analyst was provided an area in which the review of personnel and administrative files could be performed. Designee provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Nine employee files were reviewed. During review of files, Designee was unable to provide proof of affiliation with this Home Care Organization for nine of nine Home Care Aides (HCAs) and did not have proof Livescan information for the majority. Additionally Designee was Designee was not able to provide training certificates for required entry-level and annual training. Designee does not have full access to all systems required to obtain information requested. Due to time constraints, Analyst will need to return at a later date to continue this inspection. Designee was advised to review files and refrain from allowing Home Care Aides without proof of clearance and affiliation on the Home Care Aide Registry contact with clients.

Upon completion of the file review the analyst discussed the findings of the inspection with Designee Valadez. 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: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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 02/26/2025 07:21 AM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/21/2025 at 04:03 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: 374700211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2025
Section Cited
1796.45(a)
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TB TESTING:(a) 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.
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This requirement was not met as evidenced by: During the review of files Licensee was not able to provide proof of negative TB test within 90 days prior to employment, or within seven days after employmen for reference #1, #4, and #6 at time of inspection, a finding which poses an immediate health and safety risk to persons in care.
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Type A
02/22/2025
Section Cited
1796.45(c)
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TB TESTING:(c) After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection is negative shall be required to undergo an examination at least once every two years.
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This requirement was not met as evidenced by: During the review of files Licensee was not able to provide proof that Reference #2 and #9 have undergone TB testing every two years as the last negative TB test for Reference #2 found in file was dated 1/5/22 and reference #9 last TB test found in file was dated 4/25/22, 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: 02/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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