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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700250
Report Date: 06/02/2025
Date Signed: 06/02/2025 02:31:06 PM

Document Has Been Signed on 06/02/2025 02:31 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 CARE PLACEMENT - RIVERSIDEFACILITY NUMBER:
334700250
ADMINISTRATOR/
DIRECTOR:		BLAKE NAUDINFACILITY TYPE:
300
ADDRESS:11801 PIERCE ST STE 200TELEPHONE:
(619) 742-6773
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: CENSUS: DATE:
06/02/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Diego Chacon, Co-LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Enforcement Analysts (EA), Jane Cong-Huyen with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a post licensing visit. The EA met with co-licensee, Diego Chacon . The EA observed the posting of the license and operating business hours. Business operating hours are from 9am-5pm, first Monday of the month.

During the inspection, the EA reviewed personnel records for licensees since the HCO just started and has no clients and HCAs hired at this time. 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, a copy of this report (HCS809) was provided to the co-licensee, Diego Chacon, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2025
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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