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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700302
Report Date: 08/13/2025
Date Signed: 08/13/2025 02:01:19 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/13/2025 02:01 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:HOME INSTEAD SOUTH ORANGE COUNTYFACILITY NUMBER:
304700302
ADMINISTRATOR/
DIRECTOR:		KORDENBROCK JR.,JAMESFACILITY TYPE:
300
ADDRESS:33161 CAMINO CAPISTRANO, STE GTELEPHONE:
(949) 347-6767
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: CENSUS: DATE:
08/13/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Chrisitne TrautmannTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On August 13, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Home Instead South Orange County for a biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Christine Trautmann. Analyst was provided with an area in which the review of personnel and administrative files could be performed. Analyst Mangina observed the proper posting of License and business hours. Designee provided Analyst with proof of valid professional liability policy, worker's compensation, and dishonesty bond.

Upon completion of the file review Analyst discussed the findings of the inspection with Ms. Trautmann and informed Designee that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
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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