<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700137
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:23:00 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/23/2025 12:23 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:DONNINGTON HOMECAREFACILITY NUMBER:
304700137
ADMINISTRATOR/
DIRECTOR:		REBECCA RUIZFACILITY TYPE:
300
ADDRESS:11752 GARDEN GROVE BLVD STE121TELEPHONE:
(714) 530-7946
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY: CENSUS: DATE:
01/23/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:John Wildsmith, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a biennial visit. The EA met with designee, John Wildsmith. The EA observed the posting of the license and operating business hours. Business operating hours are from 11am-3pm, Monday, Tuesday and Thursday.

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

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

An exit interview was conducted, a copy of this report and appeal rights were
provided to the licensee representative, John Wildsmith via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 1