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

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700232
Report Date: 10/17/2023
Date Signed: 10/26/2023 09:16:04 AM

Document Has Been Signed on 10/26/2023 09:16 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:MANA HOME CARE, LLCFACILITY NUMBER:
374700232
ADMINISTRATOR:IGNACIO, BOBBYFACILITY TYPE:
300
ADDRESS:3186 VISTA WAY STE 309TELEPHONE:
(760) 455-8409
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: CENSUS: DATE:
10/17/2023
Post LicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jolene IgnacioTIME COMPLETED:
04:00 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
Home Care Services Bureau (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Mana Home Care LLC on 10/17/2023. Upon arrival, AGPA Vigil identified herself and was greeted by Designee, Jolene Ignacio. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with the Designee, Jolene Ignacio. The analyst informed the Designee of the deficiencies found and explained they would be noted on the 809D.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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 3
Document Has Been Signed on 10/26/2023 09:16 AM - It Cannot Be Edited


Created By: Megan Vigil On 10/17/2023 at 04:05 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: MANA HOME CARE, LLC
FACILITY NUMBER: 374700232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2023
Section Cited
1796.23
1
2
3
4
5
6
7
..Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision...
8
9
10
11
12
13
14
Home Care Aides (HCA) are providing services to the public without an eligilbe status on the HCA registry. This poses an immediate Health and Safety risk to persons in care.
8
9
10
11
12
13
14
Type A
10/31/2023
Section Cited
1796.45
1
2
3
4
5
6
7
..After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease...
8
9
10
11
12
13
14
Home Care Aides (HCA) are providing services to the public without a current TB test. This 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: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/26/2023 09:16 AM - It Cannot Be Edited


Created By: Megan Vigil On 10/17/2023 at 04:14 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: MANA HOME CARE, LLC
FACILITY NUMBER: 374700232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2023
Section Cited
1796.42
1
2
3
4
5
6
7
...(e)A home care organization licensee shall do all of the following: Report any suspected or known dependent adult or elder abuse as required by Section 15630 of the Welfare and Institutions Code...
8
9
10
11
12
13
14
The SOC 341A from was not included in the personnel folder. This poses an immediate Health and Safety risk to persons in care.
8
9
10
11
12
13
14
Type B
10/31/2023
Section Cited
1796.44
1
2
3
4
5
6
7
(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...
8
9
10
11
12
13
14
Home Care Aides did not have requred training hours logged. This poses a potential Health and Safety risk to person 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: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3