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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700372
Report Date: 08/15/2025
Date Signed: 08/15/2025 04:55:46 PM

Document Has Been Signed on 08/15/2025 04:55 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:CARE 1ST HOME CARE LLCFACILITY NUMBER:
374700372
ADMINISTRATOR/
DIRECTOR:		RIVAS, EMANUELFACILITY TYPE:
300
ADDRESS:1227 BOSTONIA STTELEPHONE:
(858) 238-7128
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: CENSUS: DATE:
08/15/2025
POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:unavailableTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 8/15/25 at 11:30 AM, Enforcement Analyst A(EA) Adrian Mangina made an attempt to perform and unannounced Plan of Correction inspection due to Designee has not provided documents requested by the Department in the attempted Post Licensing inspection conducted on 8/8/25. Designee failed to provide requested documents by the due date 8/13/25. Designee also is never present during nusiness hours and has not responded to numerous phone calls and emails.

Licensee has been advised and is once more reminded that refusal to provide records can result in revocation of the license yet continues to refuse to provide records.

Deficiencies are cited on the attached HCS809-D form. This report along with a copy of the HCS9058 Appeal Rights form was emailed to Licensee in absentia
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2025
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 08/15/2025 04:55 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 08/15/2025 at 04:43 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: CARE 1ST HOME CARE LLC
FACILITY NUMBER: 374700372

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/18/2025
Section Cited
1796.52(c)
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Inspections and Investigations; Oversight Responsibilities; Abuse Cross-Reporting: An investigation or inspection conducted by the department pursuant to this chapter may include, but is not limited to, inspection of the books, records, or premises of a home care organization. A home care organization’s refusal to make records, books, or premises available shall constitute cause for the revocation of the home care organization’s license
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This requirement was not met as evidenced by: Licensee was not present during declared business hours and has refused to return calls and emails to the Department and is thus refusing to provide records in violation of the law, return to office at request of Enforcement Analysts during today's business hours which constitutes A home care organization’s refusal to make records, books, or premises available, which poses an immediate health and safety risk to persons in care.
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Type A
08/18/2025
Section Cited
1796.37(a)(5)
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Health and Safety Code § 1796.37 (a), (5) …requirements set forth in this chapter, including all of the following…Provides the department, upon request, with a complete list of its affiliated home care aides, and proof that each satisfies the requirements of Sections 1796.43, 1796.44, and 1796.45.
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This requirement was not met as evidenced by: Designee has not complied with Plan of correction dated 8/8/25 and due 8/15/25 to provide records for all employed Home Care Aides, including a complete list of its affiliated Home Care Aides and proof that each satisfies the requirements of Sections 1796.43, 1796.44, and 1796.45, a finding which poses an immediate health and safety risk to clients 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: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2025
LIC809 (FAS) - (06/04)
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