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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700068
Report Date: 04/16/2026
Date Signed: 04/16/2026 03:57:29 PM

Document Has Been Signed on 04/16/2026 03:57 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:LAKE FOREST HOME CARE, INC.FACILITY NUMBER:
304700068
ADMINISTRATOR/
DIRECTOR:		REZAI, SAEIDFACILITY TYPE:
300
ADDRESS:23121 VERDUGO DRIVE SUITE 202TELEPHONE:
(949) 305-2431
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: CENSUS: DATE:
04/16/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Moe Fayez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA), Mila Quinto spoke to licensee, Moe Fayez to conduct a telephone pre-inspection interview. The licensee is due for a biennial visit and has agreed to a virtual visit with EA. The virtual visit is scheduled for April 21, 2026 at 2:00 pm via Microsoft Teams/FaceTime.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2026
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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