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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700316
Report Date: 02/03/2025
Date Signed: 02/03/2025 04:34:59 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/03/2025 04:34 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:CHALATI GROUP LLC.FACILITY NUMBER:
374700316
ADMINISTRATOR/
DIRECTOR:		FOURNIER, HEATHERFACILITY TYPE:
300
ADDRESS:2175 CONDOR DR #48TELEPHONE:
(619) 254-9666
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY: CENSUS: DATE:
02/03/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Noura ChalatiTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On February 3, 2025 Home Care Services Bureau (HCSB) Enforcement Analyst EA), Adrian Mangina arrived at the business office of Chalati Group, LLC for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by a family member who contacted Noura Chalati by telephone. Licensee arrived at approximately 2:55 PM. Analyst Mangina observed the proper posting of business hours and license. Analyst was provided an area in which the review of personnel and administrative files could be performed. Owner provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Two employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Licensee Chalati. 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: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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 02/03/2025 04:34 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/03/2025 at 02:56 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: CHALATI GROUP LLC.
FACILITY NUMBER: 374700316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/17/2025
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 not able to provide TB test for reference #2 a finding which poses an immediate health and safety risk to persons in care.
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Type A
02/04/2025
Section Cited
1796.44(b)(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.
(b) 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 Licensee was not able to provide proof of completion of three hours entry level safety training: basic safety, emergency proceedures, infection control 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: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/03/2025 04:34 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/03/2025 at 04:10 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: CHALATI GROUP LLC.
FACILITY NUMBER: 374700316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2025
Section Cited
1796.42(d)
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License Posting, Insurance, and Abuse Reporting: A home care organization licensee shall do all of the following:..(d) Maintain proof of general and professional liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the aggregate.
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This requirement was not met as evidenced by: during the review of files Licensee was not able to provide current proof of professional liability insurance, a finding which poses a potentiall 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: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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