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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700379
Report Date: 04/08/2025
Date Signed: 04/08/2025 12:02:27 PM

Document Has Been Signed on 04/08/2025 12:02 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:AS HOMECARE SERVICESFACILITY NUMBER:
304700379
ADMINISTRATOR/
DIRECTOR:		SERNA, AMELIAFACILITY TYPE:
300
ADDRESS:23361 EL TORO RD STE 218-BTELEPHONE:
(949) 439-6890
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: CENSUS: DATE:
04/08/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Amelia Serna, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Enforcement Analysts (EAs), Mila Quinto and Jane Cong-Huyen with the Home Care Services Branch (HCSB) conducted an on-site inspection for the purpose of a post licensing visit. The EAs met with the licensee, Amelia Serna. The EAs observed the posting of the license and operating business hours. Business operating hours are from 8:00am-12:00pm, Tuesdays and Wednesdays.

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, the EAs 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, Amelia Serna via email.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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