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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700181
Report Date: 12/17/2024
Date Signed: 12/17/2024 02:52:56 PM

Document Has Been Signed on 12/17/2024 02:52 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:CARE PARTNERS AT HOMEFACILITY NUMBER:
304700181
ADMINISTRATOR/
DIRECTOR:		RODNEY BURRISFACILITY TYPE:
300
ADDRESS:5161 CALIFORNIA AVE #200TELEPHONE:
(949) 556-3433
CITY:IRVINESTATE: CAZIP CODE:
92617
CAPACITY: CENSUS: DATE:
12/17/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Vincent Dang, DesigneeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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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, Vincent Dang. The EA observed the posting of the license and operating business hours. Business operating hours are from 8am-5pm, Monday thru Friday.

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 designee in the absence of 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 (HCS809), staff records review (HCS 859) and appeal rights were provided to the licensee representative, Vincent Dang via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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