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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700117
Report Date: 09/27/2024
Date Signed: 02/11/2025 08:42:03 AM

Document Has Been Signed on 02/11/2025 08:42 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:CAREZENFACILITY NUMBER:
304700117
ADMINISTRATOR/
DIRECTOR:		JAMIE PASCASIO-TRANFACILITY TYPE:
300
ADDRESS:16755 VON KARMAN AVE, STE 200TELEPHONE:
(800) 203-7158
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY: CENSUS: DATE:
09/27/2024
Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Jamie Pascasio-Tran, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Enforcement Analyst (EA) Mila Quinto conducted an attempted visit to the business office of Carezen. However, the licensee or designee were not present during the operational hours of Monday thru Friday from 9am-5pm. Prior to today’s attempted visit, 2 other attempted visits were conducted at the business office.

Based on today’s visit, there was no authorized representative available during EA's inspection visit. The following violation is being cited in accordance of Health and Safety Code, 1796.53 Authority to Visit HCOs . See HCS 809D.

A copy of this report with appeals rights were emailed to the licensee’s email on file.

LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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Document Has Been Signed on 02/11/2025 08:42 AM - It Cannot Be Edited


Created By: Mila Quinto On 09/27/2024 at 03:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: CAREZEN
FACILITY NUMBER: 304700117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
1796.53
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1796.53 Authority to Visit HCOs.
A duly authorized officer, employee...enter a home care organization during posted business hours, with or without advance notice...
This requirement is not met as evidenced by:
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Based on observation and interview with licensee, there was no authorized representative present during the office hours during several attempted inspection visit.
This poses a potential safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
LIC809 (FAS) - (06/04)
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