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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700341
Report Date: 10/24/2025
Date Signed: 10/24/2025 02:09:57 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/24/2025 02:09 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:CORNERSTONE CAREGIVING WEST LLCFACILITY NUMBER:
374700341
ADMINISTRATOR/
DIRECTOR:		VALENZUELA, DONNAFACILITY TYPE:
300
ADDRESS:105 N ROSE STREET, SUITE 105TELEPHONE:
(760) 546-5407
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: CENSUS: DATE:
10/24/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Nicole Maloney-VelazquezTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On October 24, 2025 , Home Care Services Bureau (HCSB) Enforcement Analyst (EA), Adrian Mangina arrived at the business office of Cornerstone Caregiving West LLC. for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and requested to speak with Designee Donna Valenzuela and was told she is out of the office until October 28. EA was greeted by Hiring and Recruiting Manager, Nicole Maloney-Velazquez who was acting Designee. Analyst Mangina observed the proper posting of License and business hours. The Analyst was provided with 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.

Upon completion of the file review the analyst discussed the findings of the inspection with Designee. 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.

NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2025
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 5
Document Has Been Signed on 10/24/2025 02:09 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/24/2025 at 01:10 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: CORNERSTONE CAREGIVING WEST LLC
FACILITY NUMBER: 374700341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2025
Section Cited
1796.23(a)
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FINGERPRINT REQUIREMENTS Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department.
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This requirement was not met as evidenced by: during the review of files on 10/24/25 Licensee could not provide proof of fingerprint clearances for reference #3 and #6, a finding which poses an immediate health and safety risk to persons in care.
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Type A
10/25/2025
Section Cited
1796.43(a)
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EMPLOYEES, VOLUNTEERS, AND AFFILIATED HOME CARE AIDE REQUIREMENTS: 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 was not met as evidenced by: During the review of files on 10/24/25, Licensee was not able to provide at time of inspection proof that to Reference #1, #2, #3, #4, #5, #6, #7, #8, #9, and #10 were affiliated and cleared on the California Home Care Aide registry prior to client contact, 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: 10/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/24/2025 02:09 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/24/2025 at 01:19 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: CORNERSTONE CAREGIVING WEST LLC
FACILITY NUMBER: 374700341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2025
Section Cited
1796.45(a)
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TB TESTING: Affiliated home care aides hired on or after January 1, 2016, 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 on 10/24/25, Licensee was not able to provide proof that Reference #1, #2, #3, #5, #6, #7, #8, #9, and obtained proof that they are free of active TB, a finding which poses an immediate health and safety risk to persons in care.
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Type A
10/25/2025
Section Cited
1796.44(b)(1)
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TRAINING REQUIRMENTS: An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows: Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
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This requirement was not met as evidenced by: During the review of files on 10/24/25 Licensee was not able to provide proof at time of inspection that Reference #1, #2, #3, #4, #5, #6, #7, #8, #9, and #10 completed entry-level 2-hour entry-level orientation training , 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: 10/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2025
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 10/24/2025 02:09 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/24/2025 at 01:35 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: CORNERSTONE CAREGIVING WEST LLC
FACILITY NUMBER: 374700341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2025
Section Cited
1796.44(b)(2)
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TRAINING REQUIREMENTS:(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: 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: A review of files on 10/24/25 found that Licensee was not able to provide proof of completion at time of inspection required 3 of 5 hours entry-level training including basic safety precautions, emergency procedures, and infections control for Reference #1, #2, #4, #5, #6, #7, #8, #9, and #10, 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: 10/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/24/2025 02:09 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/24/2025 at 01:40 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
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: CORNERSTONE CAREGIVING WEST LLC
FACILITY NUMBER: 374700341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
1796.44(c)
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TRAINING REQUIREMENTS: 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 on 10/24/25, Licensee was not able to provide proof that Reference #3 has completed 5 of 5 hours of required hours annual training at time of inspection including: 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 service, If transportation services are provided, how to safely transport a client, 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: 10/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2025
LIC809 (FAS) - (06/04)
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