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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700022
Report Date: 08/19/2024
Date Signed: 08/19/2024 11:18:30 AM

Document Has Been Signed on 08/19/2024 11:18 AM - 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:SALUS HOMECAREFACILITY NUMBER:
304700022
ADMINISTRATOR/
DIRECTOR:		MARK MORTENSENFACILITY TYPE:
300
ADDRESS:630 ROOSEVELTTELEPHONE:
(949) 390-7308
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: CENSUS: DATE:
08/19/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Susan Gonzalez, designeeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Home Care Services Branch (HCSB) Analyst, Mila Quinto arrived at the business office of Salus Homecare for a biennial inspection. Upon arrival, Analyst Quinto was greeted by designee, Susan Gonzalez. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. The Analyst reviewed the personnel and administrative files. Based on the file review, analyst informed the designee there are no discrepancies found.

The analyst provided a copy of the report to the licensee and designee via email.

LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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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