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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700038
Report Date: 09/16/2025
Date Signed: 09/16/2025 11:57:00 AM

Document Has Been Signed on 09/16/2025 11:57 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:CUSTOM CARE SOLUTIONS LLCFACILITY NUMBER:
334700038
ADMINISTRATOR/
DIRECTOR:		BECKHAM, JENNIFERFACILITY TYPE:
300
ADDRESS:73810 DINAH SHORE DRTELEPHONE:
(760) 469-4633
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY: CENSUS: DATE:
09/16/2025
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Patricia Riley, DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Enforcement Analyst (EA), Jane Cong-Huyen with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose an annual required licensing visit. EA met with the HCO representative, Pat Riley. EA observed the posting of the license and operating business hours. Business operating hours are from 9am - 5pm, 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(s). EA also reviewed the HCO’s business records including document for designee in the absence of the licensee and insurance requirements were also reviewed during the visit.

EA Cong-Huyen found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, and a copy of this report (HCS809) was provided to the licensee/HCO representative, Pat Riley, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2025
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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