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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700052
Report Date: 07/18/2024
Date Signed: 07/18/2024 11:36:16 AM

Document Has Been Signed on 07/18/2024 11:36 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:ASSURED INHOME CARE ORANGE COUNTYFACILITY NUMBER:
304700052
ADMINISTRATOR/
DIRECTOR:		TURNEY, CARLAFACILITY TYPE:
300
ADDRESS:1525 MESA VERDE DR E STE 228TELEPHONE:
(800) 925-7159
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: CENSUS: DATE:
07/18/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Gabby Zarate, DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Home Care Services Bureau (HCSB) Analyst, Mila Quinto arrived at the business office of Assured Inhome Care Orange County for a post licensing inspection. Upon arrival, Analyst Quinto was greeted by designee, Gabby Zarate. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. The Analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with designee and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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