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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 424700036
Report Date: 07/12/2024
Date Signed: 07/12/2024 11:12:37 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/12/2024 11:12 AM - 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:HELPING HANDS GROUPFACILITY NUMBER:
424700036
ADMINISTRATOR/
DIRECTOR:		RICK OLDSFACILITY TYPE:
300
ADDRESS:81 DAVID LOVE PL. #105TELEPHONE:
(805) 324-4477
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: CENSUS: DATE:
07/12/2024
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Xochitl Mendez and Marlee KingTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst Ryan Chan and Mila Quinto arrived at the business office of Helping Hands Group on 7/12/24 for a continuation of the post-licensing inspection which was initiated on 7/11/24. Upon arrival, the HCSB analysts identified themselves and were greeted by designee Xochitl Mendez, shortly after Marlee King VP of Business Development arrived during the visit. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with the designee. Designee was advised that home care aide staff who don't have proof they are free from active tuberculosis and those who don't have proof of clearance on the home care aid registry are not to be with clients. The analysts informed the designee of the deficiencies found and explained they would be noted on the 809D.

Analyst Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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 07/12/2024 11:12 AM - It Cannot Be Edited


Created By: Ryan Chan On 07/12/2024 at 06:53 AM
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: HELPING HANDS GROUP
FACILITY NUMBER: 424700036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/12/2024
Section Cited
1796.43 (a)
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1796.43 (a)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...
This requirement was not met as evidenced by:
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Based on records reviewed, licensee did not ensure that home care aides (S7 and S13) were cleared on the home care aide registry before placing them in direct care of a client which poses an immediate risk to the health and safety of clients in care.
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Type A
07/12/2024
Section Cited
1796.45(d)
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1796.45(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate...showing that the affiliated...found free from active tuberculosis disease.
This requirement was not met as evidenced by:
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Based on records reviewed licensee failed to keep a copy of home care aides tb test (S2, S3, S4, S5, S7, S8, S9, S10, S11, S12, S13, S14, and S15) on file showing HCA is free from active tuberculosis which poses an immedicate risk to the health and safety of 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/12/2024 11:12 AM - It Cannot Be Edited


Created By: Ryan Chan On 07/12/2024 at 08:10 AM
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: HELPING HANDS GROUP
FACILITY NUMBER: 424700036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2024
Section Cited
1796.44(a)
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1796.44(a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
This requirement was not met as evidenced by:
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Based on documents reviewed which shows some testing was completed by some HCAs however, training hours could not be verified, licensee failed to show proof that required training was completed by HCA staff (S1 through S15) which poses a potential risk to the health and safety of 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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