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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700247
Report Date: 05/28/2024
Date Signed: 05/28/2024 01:58:00 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/28/2024 01:58 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:UNITED CAREFACILITY NUMBER:
374700247
ADMINISTRATOR/
DIRECTOR:		CHEAL, KASEYFACILITY TYPE:
300
ADDRESS:720 GATEWAY CENTER DR. STE CTELEPHONE:
(619) 373-3533
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY: CENSUS: DATE:
05/28/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Kasey ChealTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst Adrian Mangina arrived at the business office of United Care on 5/28/2024 for a Biennial inspection. Upon arrival, the HCSB analyst identified herself and was greeted by Administrator Kasey Cheal. 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. Upon completion of the file review the analyst discussed the findings of the inspection with Administrator Kasey Cheal. The analyst informed the representative named above of the deficiency found and explained they would be noted on the HCS809-D form. In addition, the licensee was provided a copy of the HCS9058 (Appeal Rights) form.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
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 05/28/2024 01:58 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 05/28/2024 at 01:41 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: UNITED CARE
FACILITY NUMBER: 374700247

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2024
Section Cited
1796.14
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1796.14(b) An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client.
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This requirement was not met as evidenced by: During the review of files, it was observed that a reference #5, #6, and #9 (See HCS859), are not listed on the Home Care Aide Registry which poses an immediate safety threat 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: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
LIC809 (FAS) - (06/04)
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