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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700221
Report Date: 01/14/2025
Date Signed: 01/14/2025 01:51:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/14/2025 01:51 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:WEST COAST CARE AGENCY ASSISTANTS INCFACILITY NUMBER:
304700221
ADMINISTRATOR/
DIRECTOR:		MONTINOLA, IRISFACILITY TYPE:
300
ADDRESS:2230 W. CHAPMAN AVE STE 140TELEPHONE:
(949) 614-6696
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY: CENSUS: DATE:
01/14/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Shirley Politico and Luthgarde Lu FernandezTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Enforcement Analyst (EA), Mila Quinto and Jane Cong-Huyen, with the Home Care Services Branch (HCSB) conducted an on site inspection for a biennial visit. The EAs met with designee, Shirley Politico and Luthgarde "Jane" Lu Fernandez. The EAs observed the posting of the license and operating business hours. Business operating hours are from 9am-5pm, Monday thru Friday.

During the inspection, the EAs 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, EAs Quinto and Cong-Huyen found the HCO was in compliance and no deficiencies were cited. An exit interview was conducted, a copy of this report (HCS809) and staff records review (HCS 859) were provided to the licensee, Iris Versastigue via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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