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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700014
Report Date: 03/05/2026
Date Signed: 03/05/2026 10:34:10 AM

Document Has Been Signed on 03/05/2026 10:34 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:CANAAN HOME CAREFACILITY NUMBER:
374700014
ADMINISTRATOR/
DIRECTOR:		JENNIFER MARSHALLFACILITY TYPE:
300
ADDRESS:731 SOUTH HWY 101 SUITE 1K1TELEPHONE:
(858) 764-2663
CITY:SOLANA BEACHSTATE: CAZIP CODE:
92075
CAPACITY: CENSUS: DATE:
03/05/2026
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Alan MarlandTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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On March 5, 2026, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina conducted a biennial Inspection of Canaan Home Care. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Alan Marland. Analyst was provided with an area in which the review of personnel and administrative files could be performed. Analyst Mangina observed the proper posting of License and business hours. Designee provided Analyst with proof of valid professional liability policy, worker's compensation, and dishonesty bond.

Upon completion of the file review the analyst discussed the findings of the inspection with Designee. The Analyst informed the representative named above of the deficiency found and explained it would be noted on the HCS809-D form. In addition, the Licensee was provided a copy of the HCS9058 Appeal Rights form.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2026
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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Document Has Been Signed on 03/05/2026 10:34 AM - It Cannot Be Edited


Created By: Adrian L Mangina On 03/05/2026 at 10:19 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: CANAAN HOME CARE
FACILITY NUMBER: 374700014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2026
Section Cited
1796.45(a)
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TB TESTING: Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
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This requirement was not met as evidenced by: During the review of files, Licensee was not able to provide proof that Reference #3, obtained negative TB test within 90 days before hire or 7 days after, a finding which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2026
LIC809 (FAS) - (06/04)
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