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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700015
Report Date: 09/17/2025
Date Signed: 09/17/2025 12:01:55 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/17/2025 12:01 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:LEISURE CARE HOME CARE AGENCY, INC.FACILITY NUMBER:
304700015
ADMINISTRATOR/
DIRECTOR:		BLACKANN, TREVORFACILITY TYPE:
300
ADDRESS:30131 TOWN CENTER DR SUITE 205TELEPHONE:
(949) 363-7401
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: CENSUS: DATE:
09/17/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Trevor Blackann and Blair WeissTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On September 17, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Leisure Care Home Care Agency, Inc. for abiennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Blair Weiss Designee Trevor Blackann arrived a short time later. Analyst was provided with an area in which the review of personnel and administrative files could be performed. Analyst Mangina observed the proper posting of License and business hours. Designee provided Analyst with proof of valid professional liability policy, worker's compensation, and dishonesty bond.

Upon completion of the file review Analyst discussed the findings of the inspection with Designees and informed Designees that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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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