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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700066
Report Date: 12/17/2025
Date Signed: 12/17/2025 03:03:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/17/2025 03:03 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:ASSURED IN-HOME CARE LOS ANGELESFACILITY NUMBER:
194700066
ADMINISTRATOR/
DIRECTOR:		DALE PRINCEFACILITY TYPE:
300
ADDRESS:12832 VALLEY VIEW ST. STE 101TELEPHONE:
(800) 925-7159
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY: CENSUS: DATE:
12/17/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Lupe Rodriguez, DesigneeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on-site inspection for the purpose of a biennial inspection. The EA met with the designee, Lupe Rodriguez. EA observed the posting of the license and operating business hours. Business operating hours are from 8:30 am -4:30 pm, Monday and Friday.

During the inspection, the EA reviewed personnel records for licensee, and Home Care Aides including fingerprint status', registry status', Tuberculosis (TB), and required training. The Home Care Organization’s (HCO’s) business records were also reviewed during the visit including the insurance requirements.

During today’s visit, EA Quinto found the HCO was in compliance and no deficiencies were cited.

An exit interview was conducted, a copy of this report (HCS809), and staff records review (HCS 859) were provided to the designee, Lupe Rodriguez via email.

NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2025
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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