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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700264
Report Date: 06/05/2024
Date Signed: 06/05/2024 12:18:34 PM

Document Has Been Signed on 06/05/2024 12:18 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:SENIOR HELPERS EAST SAN DIEGOFACILITY NUMBER:
374700264
ADMINISTRATOR/
DIRECTOR:		ALFONSO, STARFACILITY TYPE:
300
ADDRESS:5464 GROSSMONT CTR DR STE 330TELEPHONE:
(619) 900-1982
CITY:SAN DIEGOSTATE: CAZIP CODE:
91942
CAPACITY: CENSUS: DATE:
06/05/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Saige SerranoTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst Adrian Mangina arrived at the business office of Senior Helpers East San Diego on 6/5/2024 for a Biennial inspection. Upon arrival, the HCSB analyst identified herself and was greeted by employee, Client Services Manager Charles Panna. HR Manager/Designee Saige Serrano arrived approximately 30 minutes later. 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. Analyst was provided a copy of the current insurance policies and dishonesty bond. Upon completion of the file review the analyst discussed the findings of the inspection with the Designee Saige Serrano. 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: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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 06/05/2024 12:18 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 06/05/2024 at 11:20 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: SENIOR HELPERS EAST SAN DIEGO
FACILITY NUMBER: 374700264

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2024
Section Cited
1796.23(a)
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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...
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This requirement is not met as evidenced by: During the review of files, it was observed that reference #1 and #2 did not have fingerprint clearances which poses an immediate health and safety risk to persons in care.
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Type A
06/06/2024
Section Cited
1796.43(a)
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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 is not met as evidenced by:
During the review of files, it was observed that reference #1 and #2, did not have HCA registry, a finding which poses an immediate health and safety risks 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: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/05/2024 12:18 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 06/05/2024 at 11:54 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: SENIOR HELPERS EAST SAN DIEGO
FACILITY NUMBER: 374700264

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
1796.44
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 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..a minimum of five hours of annual training.
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This requirement is not met as evidenced by:
During the review of files, it was observed that reference #11 did not have proper annual training hour in file, 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: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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