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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700138
Report Date: 02/01/2024
Date Signed: 02/01/2024 12:40:58 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/01/2024 12:40 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:FORESIDE MANAGEMENT COMPANY DBA BRIGHTSTAR CARE OFFACILITY NUMBER:
304700138
ADMINISTRATOR:MARK WOODSUMFACILITY TYPE:
300
ADDRESS:26023 ACEROTELEPHONE:
(949) 837-7000
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: CENSUS: DATE:
02/01/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:JesiccaTIME COMPLETED:
12:45 PM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Brightstar Care for a biennial inspection on 2/1/24. Upon arrival, the HCSB analyst identified himself and was greeted by Jessica . The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Jessica and informed the Designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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