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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700258
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:45:46 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/23/2025 12:45 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:LEGACY CARE LLCFACILITY NUMBER:
374700258
ADMINISTRATOR/
DIRECTOR:		CHAPELE, AMREFACILITY TYPE:
300
ADDRESS:2150 N CENTRE CITY PKWY STE KTELEPHONE:
(619) 734-7493
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: CENSUS: DATE:
01/23/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Ese ChapeleTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On January 23, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst (EA), Adrian Mangina arrived at the business office of Legacy Care LLC. for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Ese Chapele. Analyst Mangina observed the proper posting of business hours and license. The Analyst was provided an area in which the review of personnel and administrative files could be performed. Designee provided Analyst with proof of current professional liability policy, worker's compensation, and dishonesty bond. Six employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Designee Ese Chapele. 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 Designee was provided a copy of the HCS9058 Appeal Rights form.

LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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 01/23/2025 12:45 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 01/23/2025 at 11:58 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: LEGACY CARE LLC
FACILITY NUMBER: 374700258

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2025
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, Analyst observed that Reference #5's most recent TB test was administered more than 2 years ago on 5/23/22 and Licensee could not provide proof that reference #5 had undergone TB test at least once every two years at time of inspection, a finding which poses an immediate health and safety risk to persons in care.
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Type A
02/24/2025
Section Cited
1796.44(b)(2)
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Training Requirements: An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows:… (2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
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This requirement was not met as evidenced by: During the review of files, Analyst observed that Licensee could not provide proof that Reference #1, #2, #3, #4, #5, and #6 had completed three hours of required entry level training 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: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/23/2025 12:45 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 01/23/2025 at 12:10 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: LEGACY CARE LLC
FACILITY NUMBER: 374700258

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/13/2025
Section Cited
1796.44(c)
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Training Requirements (c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas: Clients’ rights and safety, How to provide for, and respond to, a client’s daily living needs, How to report, prevent, and detect abuse and neglect, How to assist a client with personal hygiene and other home care services, If transportation services are provided, how to safely transport a client.
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This requirement was not met as evidenced by: During the review of files, Analyst observed that Licensee could not provide proof that Reference #4, and #5 had completed all five hours of required entry level training at time of inspection, a finding 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: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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