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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700378
Report Date: 09/23/2025
Date Signed: 09/23/2025 03:18:42 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/23/2025 03:18 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:COMPASSIONATE COMPANION CARE OF SOUTHERN CALIFORNIFACILITY NUMBER:
304700378
ADMINISTRATOR/
DIRECTOR:		MAYLIA TSENFACILITY TYPE:
300
ADDRESS:24443 SUNRAY LANETELEPHONE:
(949) 903-6313
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: CENSUS: DATE:
09/23/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Connie RomanTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On September 23, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Compassionate Companion Care of Southern California or a biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Owner Connie Roman. 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. Roman and informed Designee that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2025
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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