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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700415
Report Date: 04/09/2024
Date Signed: 04/09/2024 12:08:12 PM

Document Has Been Signed on 04/09/2024 12:08 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:SAFE GUARD CARE SERVICES, INC.FACILITY NUMBER:
304700415
ADMINISTRATOR/
DIRECTOR:		SANDRA INCIPIDOFACILITY TYPE:
300
ADDRESS:22996 EL TORO RD STE 105TELEPHONE:
(949) 624-2400
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: CENSUS: DATE:
04/09/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Angelika Mariano TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Safe Guard Care for an initial inspection on 4/9/2024. Upon arrival, the HCSB analyst identified himself and was greeted by Angelika Mariano. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Angelika and informed the Licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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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