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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700359
Report Date: 11/26/2024
Date Signed: 11/26/2024 12:56:26 PM

Document Has Been Signed on 11/26/2024 12:56 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:1HEART CAREGIVER SERVICESFACILITY NUMBER:
304700359
ADMINISTRATOR/
DIRECTOR:		ARYABOD, ARMINFACILITY TYPE:
300
ADDRESS:14151 NEWPORT AVE. SUITE 201ATELEPHONE:
(949) 919-0137
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: CENSUS: DATE:
11/26/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Armin Aryabod, Operatioon ManagerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Enforcement Analysts (EA), Jane Cong-Huyen and Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a post visit. The EAs met with Jana Gilmore, Staffing Coordinator, and Armin Aryabod, Operation Manager. The EAs observed the posting of the license and operating business hours. Business operating hours are from 9am-5pm, Monday thru Friday and Saturday by appointment only.

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, document of designee in the absence of the license and insurance requirements.

During today’s visit, EAs Cong-Huyen and 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, Armin Aryabod via email.
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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