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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700010
Report Date: 09/03/2024
Date Signed: 09/03/2024 04:22:05 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/03/2024 04:22 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:HOME INSTEAD SENIOR CARE #281FACILITY NUMBER:
334700010
ADMINISTRATOR/
DIRECTOR:		PAUL DZIUBANFACILITY TYPE:
300
ADDRESS:41880 KALMIA ST STE 140TELEPHONE:
(951) 696-2100
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: CENSUS: DATE:
09/03/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Janette LesovskyTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Home Instead Senior Care #281 at 43533 Ridge Park Drive Suite B, Temecula, CA 92590 on September 3, 2024 for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Assistant Manager Danielle Gosser and Office Manager Janette Lesovsky. Designee stated change of location application was submitted with renewal in June 2024. Analyst Mangina observed the proper posting of business hours and license. The analyst was provided an area in which the review of personnel and administrative files could be performed. Designee Lesovsky provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Employee files were reviewed. Upon completion of the file review Analyst discussed the findings of the inspection with Designee Janette Lesovsky and informed the Designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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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