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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 104700064
Report Date: 07/24/2026
Date Signed: 07/24/2026 01:25:30 PM

Document Has Been Signed on 07/24/2026 01:25 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:HOME INSTEADFACILITY NUMBER:
104700064
ADMINISTRATOR/
DIRECTOR:		TORIO, THEODOREFACILITY TYPE:
300
ADDRESS:745 E LOCUST AVE STE 105TELEPHONE:
(559) 243-1224
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: CENSUS: DATE:
07/24/2026
Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Kim HartTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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During the course of complaint investigation 47-HC-20260514094335, Enforcement Analyst Perez identified deficiencies related to missing TB clearance documentation that were not included in the original complaint allegations. This Case Management Report is being prepared to document those deficiencies and the findings identified during the investigation. The deficiencies will be noted in the HCS 809D report and reference individuals from HCS 856 report connected to the complaint report 9099.
Ruben Perez
DATE: 07/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2026
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 07/24/2026 01:25 PM - It Cannot Be Edited


Created By: Ruben Perez On 07/24/2026 at 01:15 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: HOME INSTEAD
FACILITY NUMBER: 104700064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2026
Section Cited
1796.45
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(a) 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. TB clearance was not documented in the personnel records of caregiver(s) REF# 01 in the 859-report reviewed by the Enforcement Analyst. Failure to maintain documentation of TB clearance 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: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2026
LIC809 (FAS) - (06/04)
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