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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700901
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:26:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/15/2024 12:26 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:VISITING ANGELS GARDEN GROVEFACILITY NUMBER:
194700901
ADMINISTRATOR/
DIRECTOR:		TUNBERG, LAURAFACILITY TYPE:
300
ADDRESS:12383 LEWIS ST., STE 202TELEPHONE:
(818) 206-8121
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: CENSUS: DATE:
11/15/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Raeana Lagunas-ZaraviaTIME VISIT/
INSPECTION COMPLETED:
12:45 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 biennia licensing visit. The EA met with designee, Raeana Lagunas-Zaravia. The EA observed the posting of the license and operating business hours. Business operating hours are from 8am-5pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee, staff and Home Care Aides including fingerprint status', registry status', Tuberculosis (TB), and required training. The HCO’s business records were also reviewed during the visit including designee in the absence of the license and 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), staff records review (HCS 859) and appeal rights were provided to the licensee representative, Raeana Lagunas-Zaravia via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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