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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700321
Report Date: 03/03/2026
Date Signed: 03/03/2026 02:15:24 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/03/2026 02:15 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:ANGEL CONNECTION NURSING SERVICESFACILITY NUMBER:
194700321
ADMINISTRATOR/
DIRECTOR:		MERJILYN CHUFACILITY TYPE:
300
ADDRESS:3816 STINEMAN CT. #104TELEPHONE:
(562) 420-4695
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: CENSUS: DATE:
03/03/2026
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Laila Leah Dominguez, DesigneeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Biennial Inspection visit. The EA met with the Home Care Organization (HCO) representative named above.

During the inspection, the EA observed the posting of the license and operating business hours which show the business operates from Monday through Friday, 9AM to 5PM. EA 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 found the HCO was in compliance and no deficiencies were cited. A copy of this report, staff records review report and appeal rights were provided to the HCO representative electronically.
NAME OF LICENSING PROGRAM ANALYST: Joshua Rarela
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2026
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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