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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700122
Report Date: 03/02/2026
Date Signed: 03/03/2026 11:43:00 AM

Document Has Been Signed on 03/03/2026 11:43 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:ATIVA HOME CAREFACILITY NUMBER:
304700122
ADMINISTRATOR/
DIRECTOR:		PAN, MARVINFACILITY TYPE:
300
ADDRESS:18022 COWAN, SUITE 215TELEPHONE:
(949) 225-2188
CITY:IRVINESTATE: CAZIP CODE:
92614
CAPACITY: CENSUS: DATE:
03/02/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Marvin Pan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA), Mila Quinto spoke to licensee, Mavin Pan 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 March 6, 2026, at 10:00 am via Microsoft Teams/FaceTime.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2026
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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