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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701102
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:53:29 PM

Document Has Been Signed on 12/19/2025 02:53 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:CARE AVENUE SUPPORT SERVICES LLCFACILITY NUMBER:
194701102
ADMINISTRATOR/
DIRECTOR:		LAGARTEJA, PETER JOHNFACILITY TYPE:
300
ADDRESS:11317 FERINA STTELEPHONE:
(562) 357-7199
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: CENSUS: DATE:
12/19/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Marie Dumlao - LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Care Avenue Support Services LLC on 12/19/25 for a post licensing inspection, EA met with licensee Marie Dumlao. The proper posting of business hours and license was observed. The proof of insurance records were reviewed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with the licensee and informed her that no discrepancies were found. Licensee stated she did not have any home care aides and clients at this time, EA went over home care aide requirements such as training requirements, tb testing, home care aide registry, and background check.

EA Chan concluded the visit with an exit interview and provided a copy of this report to licensee.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2025
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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