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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700285
Report Date: 01/24/2025
Date Signed: 01/24/2025 10:57:19 AM

Document Has Been Signed on 01/24/2025 10:57 AM - 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:HOME INSTEAD - BREAFACILITY NUMBER:
304700285
ADMINISTRATOR/
DIRECTOR:		GALVAN-GARAY, NATALIAFACILITY TYPE:
300
ADDRESS:265 S RANDOLPH AVE, SUITE 230TELEPHONE:
(714) 871-4274
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: CENSUS: DATE:
01/24/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Ken Tabb, OwnerTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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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 post licensing visit. The EA met with licensee and designee, Ken Tabb and Natalia Galvan. The EA observed the posting of the license and operating business hours. Business operating hours are from 9am-5pm, Monday thru 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.


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), and appeal rights were provided to the licensee, Ken Tabb via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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