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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700374
Report Date: 06/04/2025
Date Signed: 06/04/2025 03:31:26 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/04/2025 03:31 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:ORANGE COUNTY SUPPORT SERVICES DBA HOME INSTEADFACILITY NUMBER:
304700374
ADMINISTRATOR/
DIRECTOR:		THOMAS, WILLIAMFACILITY TYPE:
300
ADDRESS:18 TECHNOLOGY DRIVE SUITE 205TELEPHONE:
(714) 624-2465
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: CENSUS: DATE:
06/04/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Steven Lee, DesigneeTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Enforcement Analysts (EAs), 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 the designee, Steven Lee. The EA observed the posting of the license and operating business hours. Business operating hours are from 9:00 am -5:00pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee, 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, the 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 Michelle Thomas and designee, Steven Lee via email.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2025
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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