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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700276
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:11:09 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/12/2024 02:11 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:PRIORITY HOME CARE LLCFACILITY NUMBER:
374700276
ADMINISTRATOR/
DIRECTOR:		MONTIEL, ERIKAFACILITY TYPE:
300
ADDRESS:441 BLACKSHAW LNTELEPHONE:
(619) 991-2702
CITY:SAN DIEGOSTATE: CAZIP CODE:
92173
CAPACITY: CENSUS: DATE:
06/12/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Erika MontielTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Analysts Adrian Mangina and Ruben Perez arrived at the business office of Priority Home Care LLC at 355 K Street, Ste N, Chula Vista, CA 91911, on 6/12/2024 for a Biennial inspection. Upon arrival, the HCSB analyst identified themselves and were greeted by Licensee Erika Montiel The proper posting of business hours and license were observed. The analysts were shown to an area where the review of personnel and administrative files could be performed. Licensee provided copies of current Liability, Workers Compensation insurance, and Dishonesty Bond. Upon completion of the file review the analysts discussed the findings of the inspection with the Ms. Montiel. The analysts 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: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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 06/12/2024 02:11 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 06/12/2024 at 01:12 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: PRIORITY HOME CARE LLC
FACILITY NUMBER: 374700276

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
1796.43(a)(2)
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TB Test 1796.43(a)1796.43(a) Home care organizations that employ affiliated home care aides shall …:
(2) Require home care aides to demonstrate that they are free of active tuberculosis disease, pursuant to Section 1796.45.
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #2 and #15 did not have TB test results in file, 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: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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