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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700103
Report Date: 08/19/2024
Date Signed: 08/19/2024 03:51:28 PM

Document Has Been Signed on 08/19/2024 03:51 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:LFQ SENIOR CARE DBA LAKE FOREST SERVICESFACILITY NUMBER:
304700103
ADMINISTRATOR/
DIRECTOR:		AGUIRRE, SERAFINFACILITY TYPE:
300
ADDRESS:22772 CENTRE DR. STE 220TELEPHONE:
(949) 583-7888
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: CENSUS: DATE:
08/19/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:55 PM
MET WITH:Marisa Cera, DesigneeTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Home Care Services Branch (HCSB) Analyst, Mila Quinto and Staff Service Manager (SSM), Susan Du arrived at the business office of LFQ Senior Care for a biennial inspection. Upon arrival, Analyst Quinto and SSM, Du was greeted by designee, Marisa Cera. 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 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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