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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700429
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:07:12 PM

Document Has Been Signed on 03/11/2025 12:07 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:ATIYA CARE LLCFACILITY NUMBER:
304700429
ADMINISTRATOR/
DIRECTOR:		SAMI BEYDOUNFACILITY TYPE:
300
ADDRESS:25255 CABOT RD STE 221TELEPHONE:
(949) 259-0989
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: CENSUS: DATE:
03/11/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Erin Elliott, DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a postlicensing visit. The EA met with the licensee, Sami Beydoun. The EA observed the posting of the license and operating business hours. Business operating hours are from 9am-4pm, 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, designee in the absence of the license and 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, Sami Beydoun via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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