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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700343
Report Date: 02/19/2025
Date Signed: 02/25/2025 01:12:06 PM

Document Has Been Signed on 02/25/2025 01:12 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:VISITING ANGELSFACILITY NUMBER:
374700343
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, GITAFACILITY TYPE:
300
ADDRESS:1155 SPORTFISHER DR. STE 120TELEPHONE:
(760) 650-0007
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY: CENSUS: DATE:
02/19/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Gita WilliamsTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On February 25, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Visiting Angels for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Owner Gita Williams. 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. Owner provided Analyst with proof of current professional liability policy, worker's compensation, and dishonesty bond. Eight employee files were reviewed.

Upon completion of the file review the analyst discussed the findings of the inspection with Ms. Williams. The Analyst informed the representative named above of the deficiencies 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: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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 02/25/2025 01:12 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/25/2025 at 12:32 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: VISITING ANGELS
FACILITY NUMBER: 374700343

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/04/2025
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:
(1) 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 Licensee was unable to provide proof that reference #1 and #5 had completed basic safety precautions, emergency procedures, and infection control, and reference #4 had completed basic safety precautions and infection control during the time of inspection, 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: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
LIC809 (FAS) - (06/04)
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