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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 574700010
Report Date: 07/25/2024
Date Signed: 07/29/2024 07:29:10 AM

Document Has Been Signed on 07/29/2024 07:29 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:ADVANCE HOME CARE SOLUTIONS INC.FACILITY NUMBER:
574700010
ADMINISTRATOR/
DIRECTOR:		JIMMY ODUSOLAFACILITY TYPE:
300
ADDRESS:327 COLLEGE ST STE 107TELEPHONE:
(916) 436-6953
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: CENSUS: DATE:
07/25/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Jim OdusolaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Enforcement Analyst (EA), Megan Vigil and Ramsey Chimienti, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Required - 2 Year inspection. The EA met with Licensee, Jim Odusola.

During the inspection, the EA observed the posting of the license and operating business hours which show the business operates from Mon-Fri, 9:00am-5:00pm. EA's, Vigil and Chimienti, reviewed the personnel records for licensee, staff and Home Care Aides. Furthermore, EA, reviewed the HCO’s business records including training agenda, abuse reporting incidents, current designee, and insurance requirements.

During today’s visit, EA's, Vigil and Chimienti, found the HCO was not in compliance and deficiencies were cited. An exit interview was conducted, a copy of the 809/809D report, staff records review report and the appeal rights were provided to the Licensee, Jim Odusola.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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 07/29/2024 07:29 AM - It Cannot Be Edited


Created By: Megan Vigil On 07/25/2024 at 02:30 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: ADVANCE HOME CARE SOLUTIONS INC.
FACILITY NUMBER: 574700010

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2024
Section Cited
1796.44
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...(c) 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:
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Home Care Aide's should have the required training accessible for the file review. This poses a potential Health and Safety risk to person 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: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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