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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700211
Report Date: 02/28/2025
Date Signed: 02/28/2025 11:03:38 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/28/2025 11:03 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:
02/28/2025
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Adrian PetersTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On February 28, 2025 Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Visiting Angels for the purpose of completing the Biennial inspection begun on 2/21/25. Upon arrival, the Enforcement Analyst identified herself and was greeted by owner Adrian Peters. Analyst Mangina continued to review employee files and discussed best practices.

Upon completion of the file review the analyst discussed the findings of the inspection with Mr. Peters 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: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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 02/28/2025 11:03 AM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/28/2025 at 07:18 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: VISITING ANGELS
FACILITY NUMBER: 374700211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/01/2025
Section Cited
1796.43(a)
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Employees, Volunteers, and Affiliated Home Care Aide Requirements: Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients.
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This requirement was not met as evidenced by: During the review of files on 2/21/25 Licensee was not able to provide proof of Home Care Registry clearance for Reference #1, #2, #3, #4, #5, #6, #7, #8, #9, #10 and #11 at time of inspection, a finding which poses an immediate health and safety risk to persons in care.
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Type A
03/01/2025
Section Cited
1796.23(a)
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fingerprint requirements: (a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d).
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This requirement was not met as evidenced by: During the review of files on 2/21/25 Licensee was not able to provide proof of fingerprint clearance for Reference #4 at time of inspection, 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: 02/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
LIC809 (FAS) - (06/04)
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