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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700010
Report Date: 03/12/2026
Date Signed: 03/12/2026 10:16:07 AM

Document Has Been Signed on 03/12/2026 10:16 AM - 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:43533 RIDGE PARK DR #BTELEPHONE:
(951) 696-2100
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: CENSUS: DATE:
03/12/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Danielle Gosser, ManagerTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA), Jane Cong-Huyen spoke to Manager, Danielle Gosser, to conduct a telephone pre-inspection interview. Licensee/Designee, confirmed HCO Information. The licensee is due for a biennial visit and has agreed to a virtual inspection visit with EA.

The virtual inspection visit is scheduled for Tuesday 3/12/2026 @ 2:00pm via Microsoft Teams. EA emailed the HCO with specific instructions regarding the virtual licensing inspection and the required documentation for the HCO to submit to EA via email by/before Friday 3/13/26.

The HCO will be receiving this report via email. HCO will send report back to EA within 24 hours with signature to confirm the virtual inspection visit.

NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2026
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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