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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700309
Report Date: 02/12/2025
Date Signed: 02/12/2025 05:11:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/12/2025 05:11 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:SENIOR HELPERS SAN DIEGO NORTHFACILITY NUMBER:
374700309
ADMINISTRATOR/
DIRECTOR:		PETERS, CORT D.FACILITY TYPE:
300
ADDRESS:111 NORTH BROADWAYTELEPHONE:
(619) 307-0352
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: CENSUS: DATE:
02/12/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Cort PetersTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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On February 12, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst (EA), Adrian Mangina arrived at the business office of Senior Helpers San Diego North for a Biennial inspection. Upon arrival, there was no staff present at the office. Designee Cort Peters arrived at approximately 2:00 PM. Enforcement Analyst identified herself and was greeted by Designee Cort Peters. 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. Ten employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Designee Peters. 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: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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 02/12/2025 05:11 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/12/2025 at 03:58 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: SENIOR HELPERS SAN DIEGO NORTH
FACILITY NUMBER: 374700309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2025
Section Cited
1796.45(a)
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TB TESTING: (a) Affiliated home care aides... shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
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This requirement was not met as evidenced by: during the review of files Licensee was unable to provide proof of negative TB test for reference #4, # 8, #9, and #10, a finding that poses an immediate health and safety risk for children in care.
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Type A
02/13/2025
Section Cited
1796.44(A)(2)
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TRAINING REQUIREMENTS:(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section...(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 Licensee was unable to provide proof of completion of three hours entry level training including basic safety precautions, emergency procedures, and infection control for reference #1, #2, #3, #4, #5, #6, #7, # 8, #9, and #10, a finding that poses an immediate health and safety risk for 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: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/12/2025 05:11 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/12/2025 at 04:22 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: SENIOR HELPERS SAN DIEGO NORTH
FACILITY NUMBER: 374700309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
1796.44(c)
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TRAINING REQUIREMENT: (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:
(1) Clients’ rights and safety.
(2) How to provide for, and respond to, a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) 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 Licensee was unable to provide proof of completion of five hours annual level training including (1) Clients’ rights and safety.
(2) How to provide for, and respond to, a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client for reference #5, a finding that poses a potential health and safety risk for 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: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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