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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700394
Report Date: 07/15/2026
Date Signed: 07/16/2026 03:27:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/16/2026 03:27 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:FLEUR DE LIS HOME CARE INC.FACILITY NUMBER:
194700394
ADMINISTRATOR/
DIRECTOR:		MARIA G. LIMFACILITY TYPE:
300
ADDRESS:5220 CLARK AVE UNIT 105TELEPHONE:
(714) 388-5486
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: CENSUS: DATE:
07/15/2026
Required - 2 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Tomas Lim - DesigneeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Enforcement Analyst (EA), Ryan Chan, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection, EA met with designee Tomas Lim. The proper posting of business hours and license was observed during the virtual tour of the facility.

During the inspection, EA reviewed personnel records for Home Care Aides (HCA) 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 found the HCO was in compliance and no deficiencies were cited.

An exit interview was conducted and a copy of this report was provided to the designee via email.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2026
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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