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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700122
Report Date: 03/06/2026
Date Signed: 03/06/2026 12:28:07 PM

Document Has Been Signed on 03/06/2026 12:28 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: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:
03/06/2026
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Marvin Pan, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection. The EA met with the licensee, Marvin Pan. Per virtual tour of the facility, EA observed the posting of the license and operating business hours. Business operating hours are from 9:00am -3:00 pm, Monday and Friday.

During the inspection, the EA reviewed personnel records for licensee, and Home Care Aides including fingerprint status', registry status', Tuberculosis (TB), and required training. The Home Care Organization’s (HCO’s) business records were also reviewed during the visit including the insurance requirements.

During today’s visit, EA Quinto found the Home Care Organization (HCO) was in compliance and no deficiencies were cited.

An exit interview was conducted, a copy of this report, Home Care Organization Evaluation Report (HCS809), and Review of Staff records (HCS 859) were provided to the licensee, Marvin Pan via email.

NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2026
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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